MEDICARE: LARRY DASHEFSKY MD INC

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	2084N0600X	Clinical Neurophysiology Physician
2	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1780873091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARRY DASHEFSKY MD INC

Provider Business Mailing Address
First Line	:	6803 MAYFIELD RD STE 409
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-2214
Country	:	US
Telephone Number	:	440-449-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6803 MAYFIELD RD STE 409
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-2214
Country	:	US
Telephone Number	:	440-449-2000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LARRY HOWARD DASHEFSKY
Credential	:	MD
Telephone Number	:	440-449-2000

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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