Healthcare Provider Details

I. General information

NPI: 1790048759
Provider Name (Legal Business Name): MEGAN JOANN MOINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN JOANN COLEMAN M.D.

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 PARK EAST DR STE 108
BEACHWOOD OH
44122-4330
US

IV. Provider business mailing address

3619 PARK EAST DR STE 108
BEACHWOOD OH
44122-4330
US

V. Phone/Fax

Practice location:
  • Phone: 216-260-3550
  • Fax: 216-265-5015
Mailing address:
  • Phone: 216-260-3550
  • Fax: 303-269-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.135193
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.135193
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0056952
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: