MEDICARE: DR. TEAH ABASHIDZE 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
1	207R00000X	Internal Medicine Physician	35083950A	OH
2	208M00000X	Hospitalist Physician	D76164	MD

Other Identifiers

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

General Provider Information

NPI Number	:	1336179647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TEAH ABASHIDZE M.D.

Provider Business Mailing Address
First Line	:	1831 FOREST HILLS BLVD
Second Line	:	SUITE 102
City	:	E CLEVELAND
State	:	OH
Zip	:	44112-4348
Country	:	US
Telephone Number	:	216-541-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4758 RIDGE RD
Second Line	:	SUITE 161
City	:	CLEVELAND
State	:	OH
Zip	:	44144-3327
Country	:	US
Telephone Number	:	440-236-8484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/17/2017

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