MEDICARE: MARY MARGARET GORJANC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35-048000	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004558586	OTHER	OH	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000201141	OTHER	OH	ANTHEM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	95357	OTHER	OH	QUAL CHOICE

General Provider Information

NPI Number	:	1144205436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MARGARET GORJANC MD

Provider Business Mailing Address
First Line	:	6900 PEARL RD
Second Line	:	STE 100
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-3639
Country	:	US
Telephone Number	:	440-292-1000
Fax Number	:	440-292-1001

Provider Business Practice Location Address
First Line	:	15900 SNOW RD STE 300
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2860
Country	:	US
Telephone Number	:	440-292-1000
Fax Number	:	440-292-1001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	01/05/2021

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