Healthcare Provider Details

I. General information

NPI: 1861693541
Provider Name (Legal Business Name): BETH HENGST GILLESPIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH ANNE HENGST M.D.

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SEVERANCE CIR
CLEVELAND HEIGHTS OH
44118-1533
US

IV. Provider business mailing address

1001 LAKESIDE E AVE 1200
CLEVELAND OH
44114-1172
US

V. Phone/Fax

Practice location:
  • Phone: 216-524-7377
  • Fax:
Mailing address:
  • Phone: 216-479-5248
  • Fax: 216-479-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35-093570
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: