Basic Information
| Provider Information | |||||||||
| NPI: | 1508959693 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TCHELIDZE | ||||||||
| FirstName: | TEA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 92938 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441942938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404664641 | ||||||||
| FaxNumber: | 4404661871 | ||||||||
| Practice Location | |||||||||
| Address1: | 254 S BROADWAY | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440411807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163830100 | ||||||||
| FaxNumber: | 2163836481 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35085308 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.