Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 35085326 | OH |
Y | 207Q00000X | Family Doctor | 35085326 | OH |
NPI | 1205878790 |
---|---|
Provider Name | Pratheep Pawa |
First Address | Canton, OH 44708-2614 |
Second Address | Carrollton, OH 44615-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 19/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000386187 | ANTHEM BC/BS URGENT CARE (01) | OH |
000000484955 | ANTHEM, BC/BS OFFICE (01) | OH |
196433 | WELLCARE URGENT CARE (01) | OH |
2700189 | (05) | OH |
340714684101 | CAREOURCE URGENT CARE (01) | OH |
340714684105 | CARESOURCE OFFICE (01) | OH |
352588 | WELLCARE OFFICE (01) | OH |
I51231 | (02) | |
P00314038 | RAILROAD CARE (01) | OH |