Provider Demographics
NPI:1386088094
Name:MCGREAL, NATALIE M (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:MCGREAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:M
Other - Last Name:KERESTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:20 OLIVE ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3165
Mailing Address - Country:US
Mailing Address - Phone:330-379-5051
Mailing Address - Fax:330-379-5074
Practice Address - Street 1:20 OLIVE ST
Practice Address - Street 2:STE. 201
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3165
Practice Address - Country:US
Practice Address - Phone:330-379-5051
Practice Address - Fax:330-379-5074
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0086149Medicaid