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NPI Code Detail

MEDICARE: MR. GREGORY P AVELLANA PA

MEDICARE: MR. GREGORY P AVELLANA PA
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
1133V00000XRegistered Dietitian5107OH
2363A00000XPhysician Assistant50.004338OH

General Provider Information

NPI Number : 1710981543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GREGORY P AVELLANA PA
Provider Business Mailing Address
First Line : 1376 MEADOW RD
Second Line :
City : COLUMBUS
State : OH
Zip : 43212-3067
Country : US
Telephone Number : 614-485-0112
Fax Number :
Provider Business Practice Location Address
First Line : 1550 W 5TH AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43212-2495
Country : US
Telephone Number : 614-488-6528
Fax Number : 614-488-0226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 01/12/2016

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