MEDICARE: TERENCE LEIGH WITHAM MD

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	2084P0800X	Psychiatry Physician	35-081587	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	260051953	OTHER	OH	RAILROAD MEDICARE PIN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000241215	OTHER	OH	ANTHEM PIN

General Provider Information

NPI Number	:	1417933755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERENCE LEIGH WITHAM MD

Provider Business Mailing Address
First Line	:	7575 NORTHCLIFF AVE
Second Line	:	SUITE 201
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3267
Country	:	US
Telephone Number	:	216-661-4577
Fax Number	:	216-661-4784

Provider Business Practice Location Address
First Line	:	7575 NORTHCLIFF AVE
Second Line	:	SUITE 201
City	:	BROOKLYN
State	:	OH
Zip	:	44144-3267
Country	:	US
Telephone Number	:	216-661-4577
Fax Number	:	216-661-4784

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/21/2019

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Directions to “ TERENCE LEIGH WITHAM MD” Practice Location

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