Basic Information
| Provider Information | |||||||||
| NPI: | 1710264320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCHAK | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7123 PEARL RD | ||||||||
| Address2: | STE.201 | ||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441304975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408427990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 18901 LAKE SHORE BLVD | ||||||||
| Address2: | |||||||||
| City: | EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441191078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165319000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2011 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | 50003351 | OH | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 363A00000X | 50.003351RX | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.