Basic Information
| Provider Information | |||||||||
| NPI: | 1407322886 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRIWEATHER | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | CDCA PEER SPECIALIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 SUPERIOR AVE E | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441142614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162208774 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8235 GREEN DR | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441252057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162697643 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2018 | ||||||||
| LastUpdateDate: | 10/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | 00836 | OH | Y | 193400000X SINGLE SPECIALTY GROUP |
No ID Information.