MEDICARE: MS. MARISSA MARIE SCALISH 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	004014	OH

General Provider Information

NPI Number	:	1568885515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARISSA MARIE SCALISH PA-C

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE
Second Line	:	A100
City	:	CLEVELAND
State	:	OH
Zip	:	44195-4254
Country	:	US
Telephone Number	:	216-444-2394
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE
Second Line	:	A100
City	:	CLEVELAND
State	:	OH
Zip	:	44195-4254
Country	:	US
Telephone Number	:	216-444-2394
Fax Number	:

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

Provider Enumeration Date	:	01/28/2014
Last Update Date	:	03/05/2014

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