MEDICARE: PRATHEEP PAWA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	35085326	OH
2	207Q00000X	Family Medicine Physician	35085326	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000386187	OTHER	OH	ANTHEM BC/BS URGENT CARE
2	P00314038	OTHER	OH	RAILROAD CARE
3	000000484955	OTHER	OH	ANTHEM, BC/BS OFFICE
4	340714684101	OTHER	OH	CAREOURCE URGENT CARE
5	196433	OTHER	OH	WELLCARE URGENT CARE
6	340714684105	OTHER	OH	CARESOURCE OFFICE
7	352588	OTHER	OH	WELLCARE OFFICE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205878790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRATHEEP PAWA MD

Provider Business Mailing Address
First Line	:	1320 MERCY DR NW
Second Line	:	SECOND FLOOR MERCY HALL
City	:	CANTON
State	:	OH
Zip	:	44708-2614
Country	:	US
Telephone Number	:	330-471-5930
Fax Number	:	330-471-5938

Provider Business Practice Location Address
First Line	:	125 CANTON RD NW
Second Line	:
City	:	CARROLLTON
State	:	OH
Zip	:	44615-1009
Country	:	US
Telephone Number	:	330-627-7641
Fax Number	:	330-627-5796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/19/2011

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Directions to “ PRATHEEP PAWA MD” Practice Location

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