Provider Demographics
NPI:1629158415
Name:OLITSKY, GALE M (SA, PA-C)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:M
Last Name:OLITSKY
Suffix:
Gender:F
Credentials:SA, PA-C
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Mailing Address - Street 1:6472 PECK RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-8881
Mailing Address - Country:US
Mailing Address - Phone:330-298-1576
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD.
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:216-707-5912
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1020950OtherNCCPA