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NPI Code Detail

MEDICARE: DR. GARY JAY DAMERT M.D.

MEDICARE: DR. GARY JAY DAMERT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician35-050453OH

General Provider Information

NPI Number : 1245342328
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY JAY DAMERT M.D.
Provider Business Mailing Address
First Line : 1001 LAKESIDE AVE E
Second Line : #1200
City : CLEVELAND
State : OH
Zip : 44114-1158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 17406 ROYALTON RD
Second Line :
City : STRONGSVILLE
State : OH
Zip : 44136-5151
Country : US
Telephone Number : 216-621-5600
Fax Number : 440-846-2832
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2006
Last Update Date : 10/04/2013

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