MEDICARE: MR. DANA MAURICE PUGH

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	1041C0700X	Clinical Social Worker
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710577374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANA MAURICE PUGH

Provider Business Mailing Address
First Line	:	3715 WARRENSVILLE CENTER RD APT 229
Second Line	:
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44122-6367
Country	:	US
Telephone Number	:	216-849-5573
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 NOBLE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1725
Country	:	US
Telephone Number	:	216-268-2400
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	06/17/2022

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