Provider Demographics
NPI:1154377976
Name:GAIDELIS, JAMES CHARLES (PA-C, RN)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:CHARLES
Last Name:GAIDELIS
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Gender:M
Credentials:PA-C, RN
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Mailing Address - Street 1:PO BOX 74751
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0834
Mailing Address - Country:US
Mailing Address - Phone:216-383-6480
Mailing Address - Fax:216-383-6745
Practice Address - Street 1:13241 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9012
Practice Address - Country:US
Practice Address - Phone:216-383-0100
Practice Address - Fax:216-383-6481
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00091401OtherMEDICARE RAILROAD
OHP00091401OtherMEDICARE RAILROAD