Provider Demographics
NPI:1386669299
Name:PEDIATRIC & ADOLESCENT UROLOGY, INC.
Entity Type:Organization
Organization Name:PEDIATRIC & ADOLESCENT UROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCMAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-376-3332
Mailing Address - Street 1:215 W BOWERY ST
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1069
Mailing Address - Country:US
Mailing Address - Phone:330-376-3332
Mailing Address - Fax:330-376-2980
Practice Address - Street 1:215 W BOWERY ST
Practice Address - Street 2:SUITE 3500
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1069
Practice Address - Country:US
Practice Address - Phone:330-376-3332
Practice Address - Fax:330-376-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0184894Medicaid
OH9282861Medicare PIN