Healthcare Provider Details

I. General information

NPI: 1902868086
Provider Name (Legal Business Name): CARMEN KATHY HANSFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 03/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E BROAD ST STE 302
ELYRIA OH
44035-6400
US

IV. Provider business mailing address

24701 EUCLID AVE THIRD FLOOR BILLING SERVICES
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-323-0258
  • Fax: 216-201-6250
Mailing address:
  • Phone: 440-323-0258
  • Fax: 216-201-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35051857
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: