Healthcare Provider Details

I. General information

NPI: 1235550211
Provider Name (Legal Business Name): GEORGE ANTHONY KARAMBELLAS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

730 W MARKET ST
LIMA OH
45801-4602
US

V. Phone/Fax

Practice location:
  • Phone: 419-226-4310
  • Fax: 419-226-4315
Mailing address:
  • Phone: 419-226-4310
  • Fax: 419-226-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9107722
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50005705RX
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierY0L5B
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerBCBS OF FLORIDA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: