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General NPI Number Information
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NPI Number | 1558550434
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Entity Type | Organization
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Legal Business Name | CLEVELAND GERIATRICS INC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 3 MERIT DR
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City | RICHMOND HTS
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State | OH
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Zip | 44143-1457
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Country | US
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Telephone | 216-261-1500
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Fax | 216-261-8970
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Provider Business Mailing Address
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Address Line | 1460 BURLINGTON RD
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City | CLEVELAND HTS
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State | OH
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Zip | 44118-1261
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Country | US
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Telephone | 216-261-1500
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Fax | 216-261-8970
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LAWRENCE KEITH GRAY
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Credential | MD
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Telephone | 216-261-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 35048187G
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License Number State | OH
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