Provider Demographics
NPI:1497963532
Name:PASAM, TRESA PHILOMENA (MD)
Entity Type:Individual
Prefix:
First Name:TRESA
Middle Name:PHILOMENA
Last Name:PASAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 MOZART DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2357
Mailing Address - Country:US
Mailing Address - Phone:216-315-0108
Mailing Address - Fax:
Practice Address - Street 1:822 KUMHO DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9297
Practice Address - Country:US
Practice Address - Phone:333-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57009955207Q00000X
OH35.091311208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH020092Medicare PIN