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NPI Code Detail

MEDICARE: HOWARD J WIDMANN PA-C

MEDICARE:   HOWARD J WIDMANN  PA-C
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
1363A00000XPhysician Assistant50-000728OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00203681OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000342194OTHEROHANTHEM

General Provider Information

NPI Number : 1881677250
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOWARD J WIDMANN PA-C
Provider Business Mailing Address
First Line : PO BOX 74647
Second Line :
City : CLEVELAND
State : OH
Zip : 44194-0730
Country : US
Telephone Number : 440-879-0081
Fax Number : 440-879-0084
Provider Business Practice Location Address
First Line : 6780 MAYFIELD RD
Second Line :
City : MAYFIELD HTS
State : OH
Zip : 44124-2203
Country : US
Telephone Number : 440-449-4500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 07/08/2007

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Directions to “ HOWARD J WIDMANN PA-C” Practice Location

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