Provider Demographics
NPI:1770058182
Name:GREWE, AUSTIN WILLIAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:WILLIAM
Last Name:GREWE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16687 SAINT CLAIR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CALCUTTA
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9401
Mailing Address - Country:US
Mailing Address - Phone:330-967-1793
Mailing Address - Fax:234-338-9722
Practice Address - Street 1:16687 SAINT CLAIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:CALCUTTA
Practice Address - State:OH
Practice Address - Zip Code:43920-9401
Practice Address - Country:US
Practice Address - Phone:330-967-1793
Practice Address - Fax:234-338-9722
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA060214363A00000X
OH50.008642RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant