Provider Demographics
NPI:1679825947
Name:PAULRAJ-CHARLES, MAXINE (CNP)
Entity type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:
Last Name:PAULRAJ-CHARLES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22665 BARD AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2908
Mailing Address - Country:US
Mailing Address - Phone:440-777-1867
Mailing Address - Fax:
Practice Address - Street 1:26908 DETROIT RD
Practice Address - Street 2:STE. 200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2398
Practice Address - Country:US
Practice Address - Phone:440-250-8660
Practice Address - Fax:440-250-8639
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13561-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0075883Medicaid
OH0075883Medicaid