Provider Demographics
NPI:1750343422
Name:WAWROWSKI, RAYMOND H (PA-C)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:H
Last Name:WAWROWSKI
Suffix:
Gender:M
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 1:8423 MARKET ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-729-8700
Mailing Address - Fax:330-729-8701
Practice Address - Street 1:5700 DARROW ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236
Practice Address - Country:US
Practice Address - Phone:330-656-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000848RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082876Medicaid
OH0082876Medicaid