Provider Demographics
NPI:1245232867
Name:CLASSEN, GARY (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:CLASSEN
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:PO BOX 931286
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-1494
Mailing Address - Country:US
Mailing Address - Phone:888-719-9012
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-384-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340025052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0322127Medicaid
OHP00278914OtherRAILROAD MEDICARE
OH4211783Medicare PIN
OH0322127Medicaid