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NPI Code Detail

MEDICARE: DR. MARY M. LORENTZ CLOUGH M.D.

MEDICARE: DR. MARY M. LORENTZ CLOUGH 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
1208000000XPediatrics Physician35-032333OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265546113
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY M. LORENTZ CLOUGH M.D.
Provider Business Mailing Address
First Line : 12201 EUCLID AVE
Second Line : #1200
City : CLEVELAND
State : OH
Zip : 44106-4310
Country : US
Telephone Number : 216-707-3427
Fax Number : 216-707-3529
Provider Business Practice Location Address
First Line : 10 SEVERANCE CIR
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-1533
Country : US
Telephone Number : 216-621-5600
Fax Number : 440-975-4690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 06/02/2016

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