Healthcare Provider Details

I. General information

NPI: 1346335692
Provider Name (Legal Business Name): JOANNE CLARAGE MORTIMER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JOANNE MORTIMER DRAIN

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8819 QUINCY AVE
CLEVELAND OH
44106-3445
US

IV. Provider business mailing address

13800 SHAKER BLVD #804
CLEVELAND OH
44120-1584
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-2177
  • Fax:
Mailing address:
  • Phone: 216-751-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.053356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: