Basic Information
| Provider Information | |||||||||
| NPI: | 1851544753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHEAST OHIO HEART ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Practice Location | |||||||||
| Address1: | 36100 EUCLID AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409518360 | ||||||||
| FaxNumber: | 4409519408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2008 | ||||||||
| LastUpdateDate: | 10/23/2008 | ||||||||
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| AuthorizedOfficialLastName: | DOYLE | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | MBR | ||||||||
| AuthorizedOfficialTelephone: | 4409518360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35-045614 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.