Provider Demographics
NPI:1700971694
Name:BIRDSELL, JOHN PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:BIRDSELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:PAUL
Other - Last Name:BIRDSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8787 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6809
Mailing Address - Country:US
Mailing Address - Phone:216-739-7000
Mailing Address - Fax:216-739-7094
Practice Address - Street 1:7426 GOODWALT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2033
Practice Address - Country:US
Practice Address - Phone:216-832-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50 000903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical