Provider Demographics
NPI:1164423331
Name:GAYDOS, EDWARD JOHN (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHN
Last Name:GAYDOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-1154
Mailing Address - Country:US
Mailing Address - Phone:330-670-0442
Mailing Address - Fax:
Practice Address - Street 1:6559 WILSON MILLS RD
Practice Address - Street 2:BLDG D SUITE 101
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-6402
Practice Address - Country:US
Practice Address - Phone:440-473-0010
Practice Address - Fax:440-460-2812
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004907208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000025802OtherUNICARE LIFE AND HEALTH
OH0812213Medicaid
OHK04907OtherSUMMACARE HEALTH PLAN
OH386527OtherWELLCARE
OH000000025802OtherANTHEM BCBS