Healthcare Provider Details

I. General information

NPI: 1508858705
Provider Name (Legal Business Name): LARISA LEONIDOVNA GAMERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 MAYFIELD RD
CHESTERLAND OH
44026-2593
US

IV. Provider business mailing address

8254 MAYFIELD RD
CHESTERLAND OH
44026-2593
US

V. Phone/Fax

Practice location:
  • Phone: 440-729-9000
  • Fax: 440-729-0519
Mailing address:
  • Phone: 440-729-9000
  • Fax: 440-729-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number86185
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: