Provider Demographics
NPI:1467440958
Name:PANTELAKIS, JAMES N (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:PANTELAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6615 CLINGAN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2196
Mailing Address - Country:US
Mailing Address - Phone:330-729-9910
Mailing Address - Fax:330-318-6257
Practice Address - Street 1:6615 CLINGAN RD
Practice Address - Street 2:SUITE A
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2196
Practice Address - Country:US
Practice Address - Phone:330-729-9910
Practice Address - Fax:330-318-6257
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35071230P207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2202628Medicaid
OHH22948Medicare UPIN
OH2202628Medicaid