Provider Demographics
NPI:1235116906
Name:OLITSKY, TERRENCE M (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:M
Last Name:OLITSKY
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:26953 SOUTHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1156
Mailing Address - Country:US
Mailing Address - Phone:440-427-9596
Mailing Address - Fax:440-989-1153
Practice Address - Street 1:4804 LEAVITT RD
Practice Address - Street 2:STE A
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2139
Practice Address - Country:US
Practice Address - Phone:440-989-2066
Practice Address - Fax:440-989-1153
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50-000885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant