Provider Demographics
NPI:1437230307
Name:CONVERY, PATRICK G (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:G
Last Name:CONVERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 714328
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-4328
Mailing Address - Country:US
Mailing Address - Phone:440-354-1985
Mailing Address - Fax:440-350-4938
Practice Address - Street 1:36060 EUCLID AVE STE 203
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4661
Practice Address - Country:US
Practice Address - Phone:440-602-6670
Practice Address - Fax:440-602-6671
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25052111C207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0607605Medicaid
E96286Medicare UPIN
OH4107732Medicare PIN