MEDICARE: EDWARD MAHAMBA

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	246QL0900X	Laboratory Management Specialist/Technologist		OH

General Provider Information

NPI Number	:	1871423566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD MAHAMBA

Provider Business Mailing Address
First Line	:	6994 INDEPENDENCE BLVD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1214
Country	:	US
Telephone Number	:	713-459-9115
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 EAST BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1702
Country	:	US
Telephone Number	:	216-791-3800
Fax Number	:

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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Directions to “ EDWARD MAHAMBA ” Practice Location

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