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General NPI Number Information
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NPI Number | 1710981543
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Entity Type | Individual
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Provider Name | GREGORY P AVELLANA PA
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 1550 W 5TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43212-2495
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Country | US
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Telephone | 614-488-6528
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Fax | 614-488-0226
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Provider Business Mailing Address
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Address Line | 1376 MEADOW RD
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City | COLUMBUS
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State | OH
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Zip | 43212-3067
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Country | US
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Telephone | 614-485-0112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 5107
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.004338
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License Number State | OH
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