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General NPI Number Information
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NPI Number | 1376816330
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Entity Type | Individual
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Provider Name | GLORIA J KOOMSON M.D
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Gender | Female
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 14243 TRISKETT RD APT 203K
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City | CLEVELAND
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State | OH
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Zip | 44111-2329
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Country | US
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Telephone | 216-200-1791
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Fax |
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Provider Business Mailing Address
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Address Line | 2082 WINDHAM ST NE STE 101
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City | CANTON
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State | OH
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Zip | 44721-2528
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Country | US
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Telephone | 330-361-0329
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01086745A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A175239
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 01086745A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 35133932
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License Number State | OH
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