Provider Demographics
NPI:1912120239
Name:DRS. SARIDAKIS, SCANLON & SARIDAKIS, INC.
Entity Type:Organization
Organization Name:DRS. SARIDAKIS, SCANLON & SARIDAKIS, INC.
Other - Org Name:SARIDAKIS & SCANLON, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-468-0437
Mailing Address - Street 1:1440 ROCKSIDE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2774
Mailing Address - Country:US
Mailing Address - Phone:216-749-5877
Mailing Address - Fax:216-749-7808
Practice Address - Street 1:1440 ROCKSIDE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2774
Practice Address - Country:US
Practice Address - Phone:216-749-5877
Practice Address - Fax:216-749-7808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSA9163573Medicare ID - Type UnspecifiedPARMA