Provider Demographics
NPI:1407891294
Name:PAKOSZ, LAUREN G (PA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:G
Last Name:PAKOSZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MONROE ST UNIT 111
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2779
Mailing Address - Country:US
Mailing Address - Phone:567-585-0005
Mailing Address - Fax:567-585-0007
Practice Address - Street 1:5700 MONROE ST UNIT 111
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2779
Practice Address - Country:US
Practice Address - Phone:567-585-0005
Practice Address - Fax:567-585-0007
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002266363A00000X
OH50003243363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074794Medicaid
VA0110002266OtherSTATE LICENSE AS A PA