Theodore Marino Ezekiel Gagianas, PA-C
Physician Assistant, Surgical in Salem, OH. Individual provider (NPI-1).
NPI number1396100749
StatusActive
Last updated in NPPESDec 6, 2022
Details
- NPI
- 1396100749
- Entity type
- Individual (NPI-1)
- Name
- Mr. Theodore Marino Ezekiel Gagianas
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 29, 2015
- Certification date
- Dec 6, 2022
- Last updated
- Dec 6, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | 50.007297 | OH | Yes |
| 363AS0400X | Physician Assistant, Surgical | MA058003 | PA | |
| 363AS0400X | Physician Assistant, Surgical | OA003697 | PA |
Practice location
1995 E State StSalem, OH 44460-2423
Phone 330-332-7840 · Fax 330-332-7847
Mailing address
1995 E State StSalem, OH 44460-2423
Phone 330-332-7840 · Fax 330-332-7847
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