Healthcare Provider Details

I. General information

NPI: 1720142268
Provider Name (Legal Business Name): RAYMOND LENGEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LAKESIDE AVE E SUITE 1000
CLEVELAND OH
44114-1158
US

IV. Provider business mailing address

9207 VICTORIA LN
NORTH RIDGEVILLE OH
44035-8584
US

V. Phone/Fax

Practice location:
  • Phone: 888-444-4850
  • Fax:
Mailing address:
  • Phone: 440-327-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP07037
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN280327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: