Provider Demographics
NPI:1790549244
Name:TERZOLA, MADELINE GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:GRACE
Last Name:TERZOLA
Suffix:
Gender:F
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 1:3440 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7595
Mailing Address - Country:US
Mailing Address - Phone:330-807-3298
Mailing Address - Fax:
Practice Address - Street 1:3239 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2549
Practice Address - Country:US
Practice Address - Phone:330-923-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008627RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant