MEDICARE: GABRIELLE CARDAMONE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.004549RX	OH

General Provider Information

NPI Number	:	1457710634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE CARDAMONE PA-C

Provider Business Mailing Address
First Line	:	29325 HEALTH CAMPUS DR STE 3
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-8201
Country	:	US
Telephone Number	:	440-414-9400
Fax Number	:	440-808-3618

Provider Business Practice Location Address
First Line	:	7255 OLD OAK BLVD STE C408
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-3331
Country	:	US
Telephone Number	:	440-414-9500
Fax Number	:	440-260-0552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	04/16/2019

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