Healthcare Provider Details

I. General information

NPI: 1205878790
Provider Name (Legal Business Name): PRATHEEP PAWA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CANTON RD NW
CARROLLTON OH
44615-1009
US

IV. Provider business mailing address

1320 MERCY DR NW SECOND FLOOR MERCY HALL
CANTON OH
44708-2614
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-7641
  • Fax: 330-627-5796
Mailing address:
  • Phone: 330-471-5930
  • Fax: 330-471-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number35085326
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35085326
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: