Healthcare Provider Details

I. General information

NPI: 1992797989
Provider Name (Legal Business Name): MARTIN L. RIBOVICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41201 SCHADDEN RD
ELYRIA OH
44035-2220
US

IV. Provider business mailing address

5260 SMITH RD
BROOKPARK OH
44142-1747
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-0440
  • Fax:
Mailing address:
  • Phone: 216-286-6295
  • Fax: 216-286-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35069892
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: