Provider Demographics
NPI:1619089802
Name:JAMES P. BANGAYAN
Entity Type:Organization
Organization Name:JAMES P. BANGAYAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADEJ
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:440-842-6781
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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3437213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2686311Medicaid
OH5788790001Medicare NSC
OH9362841Medicare PIN
OHV09774Medicare UPIN