Healthcare Provider Details

I. General information

NPI: 1588615652
Provider Name (Legal Business Name): ARCHANA A GORTY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 10/18/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE WL10
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE WL10
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 440-899-5555
  • Fax:
Mailing address:
  • Phone: 440-899-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number35094399
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number35094399
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number35.094399
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: