MEDICARE: DR. LINCOLN MATHER CLEVELAND 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	207P00000X	Emergency Medicine Physician	174466	NY

General Provider Information

NPI Number	:	1841410925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINCOLN MATHER CLEVELAND MD

Provider Business Mailing Address
First Line	:	175 W 73RD ST APT 10F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-2933
Country	:	US
Telephone Number	:	212-362-6496
Fax Number	:	212-362-6496

Provider Business Practice Location Address
First Line	:	70 PINE STREET
Second Line	:	26TH FLOOR AIG MEDICAL DEPT
City	:	NEW YORK
State	:	NY
Zip	:	10270
Country	:	US
Telephone Number	:	212-770-5117
Fax Number	:	212-825-5127

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	12/16/2019

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