Healthcare Provider Details

I. General information

NPI: 1205829082
Provider Name (Legal Business Name): HARBOR MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 LAKE AVE
ASHTABULA OH
44004-3262
US

IV. Provider business mailing address

611 LAKE AVE
ASHTABULA OH
44004-3262
US

V. Phone/Fax

Practice location:
  • Phone: 440-964-0616
  • Fax: 440-964-3703
Mailing address:
  • Phone: 440-964-0616
  • Fax: 440-964-3703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002513
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES LAMBROS
Title or Position: PRESIDENT
Credential:
Phone: 440-964-0616