Individual
MR. THEODORE MARINO EZEKIEL GAGIANAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1995 E STATE ST, SALEM, OH 44460-2423
(330) 332-7840
(330) 332-7847
Mailing address
1995 E STATE ST, SALEM, OH 44460-2423
(330) 332-7840
(330) 332-7847
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50.007297
OH
363AS0400X
Surgical Physician Assistant
MA058003
PA
363AS0400X
Surgical Physician Assistant
OA003697
PA
Other
Enumeration date
12/29/2015
Last updated
12/06/2022
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