Provider Demographics
NPI:1487664215
Name:PARISI, EDWARD J (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:PARISI
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 1:50 N MILLER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3702
Mailing Address - Country:US
Mailing Address - Phone:330-836-9721
Mailing Address - Fax:330-836-9627
Practice Address - Street 1:50 N MILLER RD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3702
Practice Address - Country:US
Practice Address - Phone:330-836-9721
Practice Address - Fax:330-836-9627
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0893243Medicaid
OH000000140416OtherANTHEM
OH0893243Medicaid
OH000000140416OtherANTHEM