Healthcare Provider Details

I. General information

NPI: 1477518975
Provider Name (Legal Business Name): SUPRIYA GOYAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 SNOW RD
PARMA OH
44130-1002
US

IV. Provider business mailing address

1001 LAKESIDE AVE E STE 1200
CLEVELAND OH
44114-1172
US

V. Phone/Fax

Practice location:
  • Phone: 216-524-7377
  • Fax:
Mailing address:
  • Phone: 216-479-5248
  • Fax: 216-479-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35-095149
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: