Provider Demographics
NPI:1861521460
Name:PAVELKA, JAMES C (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:PAVELKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635063
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5063
Mailing Address - Country:US
Mailing Address - Phone:513-569-2043
Mailing Address - Fax:513-569-5199
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3027
Practice Address - Country:US
Practice Address - Phone:513-862-1888
Practice Address - Fax:513-862-3616
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24369174400000X
CAA92102207VX0201X
OH35-092322207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7900073650Medicaid
OH2905824Medicaid
OH2905824Medicaid
KY0969464Medicare PIN