Provider Demographics
NPI:1083800932
Name:JAMES N PANTELAKIS MD INC
Entity Type:Organization
Organization Name:JAMES N PANTELAKIS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:PANTELAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-729-9910
Mailing Address - Street 1:6615 CLINGAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2196
Mailing Address - Country:US
Mailing Address - Phone:330-729-9910
Mailing Address - Fax:330-318-6257
Practice Address - Street 1:6615 CLINGAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2196
Practice Address - Country:US
Practice Address - Phone:330-729-9910
Practice Address - Fax:330-318-6257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG4723Medicare PIN
OH4588220001Medicare NSC
OH9327091Medicare PIN