Healthcare Provider Details

I. General information

NPI: 1306086137
Provider Name (Legal Business Name): HEATHER DIANE WADAMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 07/22/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLEVELAND CLINIC 9500 EUCLID AVE
CLEVELAND OH
44195-3567
US

IV. Provider business mailing address

9500 EUCLID AVE
CLEVELAND OH
44195-3567
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-5437
  • Fax: 216-636-6761
Mailing address:
  • Phone: 216-444-5437
  • Fax: 402-955-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number33683
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57135
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35.151148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: