Provider Demographics
NPI:1245800168
Name:PAETH, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:PAETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5146 HALLGATE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-3020
Mailing Address - Country:US
Mailing Address - Phone:419-806-9908
Mailing Address - Fax:
Practice Address - Street 1:5146 HALLGATE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-3020
Practice Address - Country:US
Practice Address - Phone:419-806-9908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199876Medicaid