=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487615514
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA ELIZABETH KAPRALY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2006
-----------------------------------------------------
Last Update Date | 06/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 W OTTAWA ST
-----------------------------------------------------
City | RICHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43344-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-943-2354
-----------------------------------------------------
Fax | 740-943-5068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19 W OTTAWA ST
-----------------------------------------------------
City | RICHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43344-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-943-2354
-----------------------------------------------------
Fax | 740-943-5068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 35-06-0618
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------