Provider Demographics
NPI:1598956633
Name:DEARTH, JASON ERIC (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ERIC
Last Name:DEARTH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ALLEN BRADLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:813-289-9613
Mailing Address - Fax:484-253-1790
Practice Address - Street 1:300 ALLEN BRADLEY DRIVE
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:484-253-1790
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002628363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA29213Medicare PIN