Basic Information
| Provider Information | |||||||||
| NPI: | 1386690170 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAYER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20455 LORAIN RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRVIEW PARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441263494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403334383 | ||||||||
| FaxNumber: | 4403334192 | ||||||||
| Practice Location | |||||||||
| Address1: | 20455 LORAIN RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAIRVIEW PARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441263494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403334383 | ||||||||
| FaxNumber: | 4403334192 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34007987 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2411956 | 05 | OH | MEDICAID |