Active NPI
Terrence M Olitsky, PA-C
- Physician Assistant
- Lorain, OH
National Provider Identifier
1235116906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50-000885
- Practice address
- 4804 Leavitt Rd
Ste a
Lorain, OH 44053-2139 - Phone
- (440) 989-2066
- Fax
- (440) 989-1153
- NPI assigned
- Dec 23, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 50-000885 | OH | Primary |
Addresses
Primary practice location
4804 Leavitt Rd
Ste a
Lorain, OH 44053-2139
Mailing address
26953 Southwood LN
Olmsted Falls, OH 44138-1156
Phone (440) 427-9596
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50-000885 | OH | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1235116906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26953 SOUTHWOOD LN",
"city": "OLMSTED FALLS",
"state": "OH",
"postal_code": "441381156",
"telephone_number": "440-427-9596",
"fax_number": "440-989-1153"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4804 LEAVITT RD",
"address_2": "STE A",
"city": "LORAIN",
"state": "OH",
"postal_code": "440532139",
"telephone_number": "440-989-2066",
"fax_number": "440-989-1153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLITSKY",
"first_name": "TERRENCE",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50-000885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.