Provider Demographics
NPI:1861444648
Name:PATHADAN, PAUL A (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:PATHADAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1675 E MAIN ST # 328
Mailing Address - Street 2:OHIO IMAGING ASSOCIATES, INC
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-5818
Mailing Address - Country:US
Mailing Address - Phone:330-593-1049
Mailing Address - Fax:330-677-8770
Practice Address - Street 1:1675 E MAIN ST # 328
Practice Address - Street 2:OHIO IMAGING ASSOCIATES, INC
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-5818
Practice Address - Country:US
Practice Address - Phone:330-593-1049
Practice Address - Fax:330-677-8770
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-07-6559-P2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2126694Medicaid
OHP01573668OtherRAILROAD MEDICARE
OHP01573668OtherRAILROAD MEDICARE
OHH283910Medicare PIN
OH2126694Medicare ID - Type Unspecified
OH000000186073OtherANTHEM
OH027978400OtherFEB BLK LNG
OH0886002Medicare ID - Type Unspecified
127593300OtherUS DEPARTMENT OF LABOR
OH0886001Medicare ID - Type Unspecified