Provider Demographics
NPI:1497945216
Name:SCIALLIS, ANDREW P (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:SCIALLIS
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:GAMMA KNIFE CENTER
Mailing Address - Street 2:9410 CARNEGIE AVENUE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106
Mailing Address - Country:US
Mailing Address - Phone:216-445-7695
Mailing Address - Fax:216-444-8238
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-5054
Practice Address - Country:US
Practice Address - Phone:216-444-2200
Practice Address - Fax:216-444-8238
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103725207ZC0500X, 207ZP0101X, 207ZP0102X
MN51263207ZP0102X
390200000X
OH35.143834207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNENROLLEDMedicaid
MN220001285Medicare PIN