Healthcare Provider Details

I. General information

NPI: 1942296090
Provider Name (Legal Business Name): ARLENE GRACE ROBLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 N LEAVITT RD
AMHERST OH
44001-1131
US

IV. Provider business mailing address

24701 EUCLID AVE
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-282-7408
  • Fax: 440-960-2214
Mailing address:
  • Phone: 440-282-7408
  • Fax: 440-960-2214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35-084456
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2524021
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: