Healthcare Provider Details

I. General information

NPI: 1184896391
Provider Name (Legal Business Name): YEVGENIYA GUREVICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-0140
  • Fax: 330-543-5207
Mailing address:
  • Phone: 330-543-0140
  • Fax: 330-543-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004676RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: