Healthcare Provider Details

I. General information

NPI: 1679861223
Provider Name (Legal Business Name): AMRITA REBECCA JOHN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-1988
  • Fax: 216-844-1632
Mailing address:
  • Phone: 216-844-1988
  • Fax: 216-844-1632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02231
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number100496
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: