Provider Demographics
NPI:1083602262
Name:TSIVITSE, PAUL TERRY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TERRY
Last Name:TSIVITSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:1N
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-3588
Mailing Address - Fax:330-375-7615
Practice Address - Street 1:75 ARCH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1429
Practice Address - Country:US
Practice Address - Phone:330-535-1510
Practice Address - Fax:330-535-1638
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-05-8009207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495067Medicaid
OH0495067Medicaid
OH0897841Medicare ID - Type Unspecified