MEDICARE: DR. NORMAN ANDREW CLEMENS M.D.

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	2084P0800X	Psychiatry Physician	35-025676	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50088	OTHER	OH	QUALCHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	293982000	OTHER	OH	MAGELLAN MIS#
4	000000113753	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1871570408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORMAN ANDREW CLEMENS M.D.

Provider Business Mailing Address
First Line	:	2258 LAMBERTON RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3552
Country	:	US
Telephone Number	:	216-371-4373
Fax Number	:	216-371-4839

Provider Business Practice Location Address
First Line	:	2258 LAMBERTON RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-3552
Country	:	US
Telephone Number	:	216-371-4373
Fax Number	:	216-371-4839

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

Provider Enumeration Date	:	12/24/2005
Last Update Date	:	08/01/2011

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