Provider Demographics
NPI:1881608511
Name:BORTMAS PANTALONE, MARSHA J (CRNA)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:J
Last Name:BORTMAS PANTALONE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER ROAD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:216-844-3781
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN225715367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH751175OtherBUCKEYE MEDICAID
OH000000221293OtherUNISON
OH000000515984OtherANTHEM
OH0583328OtherBCMH
OH415017OtherWELLCARE MEDICAID
OHP00678090OtherMEDICARE RAILROAD
OH2463838Medicaid
OH430026421OtherRAILROAD MEDICARE
OH9067058OtherAETNA
OH9067058OtherAETNA
OH751175OtherBUCKEYE MEDICAID