Provider Demographics
NPI:1417102641
Name:PARTNERS PHYSICIAN GROUP
Entity Type:Organization
Organization Name:PARTNERS PHYSICIAN GROUP
Other - Org Name:CHARUDUTT N. PARANJAPE, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, FINANCE & OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-344-6095
Mailing Address - Street 1:PO BOX 715146
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5146
Mailing Address - Country:US
Mailing Address - Phone:330-576-0200
Mailing Address - Fax:330-576-0255
Practice Address - Street 1:1400 S ARLINGTON ST
Practice Address - Street 2:#38
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3750
Practice Address - Country:US
Practice Address - Phone:330-724-5471
Practice Address - Fax:330-786-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9338635OtherPPG MEDICARE GROUP #
OH000000249023OtherUNISON #
OH1841239274OtherMEDICARE GROUP NPI #
OH9338635OtherPPG MEDICARE GROUP #