Provider Demographics
NPI:1659452373
Name:ROXAS, CARMELO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARMELO
Middle Name:
Last Name:ROXAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:CARMELO
Other - Middle Name:
Other - Last Name:ROXAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:7168 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2889
Mailing Address - Country:US
Mailing Address - Phone:330-285-2270
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:216-231-3289
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-001665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant