Healthcare Provider Details

I. General information

NPI: 1922092386
Provider Name (Legal Business Name): RYAN JAMES VOGELGESANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 POWERS BLVD STE 203
PARMA OH
44129-5464
US

IV. Provider business mailing address

24701 EUCLID AVE
EUCLID OH
44117-1714
US

V. Phone/Fax

Practice location:
  • Phone: 440-845-1500
  • Fax: 440-845-9227
Mailing address:
  • Phone: 440-845-1500
  • Fax: 440-845-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35072903V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: