Provider Demographics
NPI:1477569051
Name:BANGAYAN, JAMES PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:BANGAYAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:PATRICK
Other - Last Name:BANGAYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:6681 RIDGE RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5713
Mailing Address - Country:US
Mailing Address - Phone:440-842-6781
Mailing Address - Fax:440-842-6797
Practice Address - Street 1:6681 RIDGE RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5713
Practice Address - Country:US
Practice Address - Phone:440-842-6781
Practice Address - Fax:440-842-6797
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3437213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686311Medicaid
OH4187871Medicare PIN
OH5788790001Medicare NSC
OHV09774Medicare UPIN