Individual
EILEEN M O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
24723 DETROIT RD, WESTLAKE, OH 44145-2526
(440) 617-7027
(440) 892-9083
Mailing address
24723 DETROIT RD, WESTLAKE, OH 44145-2526
(440) 617-7027
(440) 892-9083
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50-000660
OH
363AS0400X
Surgical Physician Assistant
50000660
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000325952
ANTHEM
OH
Enumeration date
04/10/2006
Last updated
06/14/2019
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