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NPI Code Detail

MEDICARE: TIMOTHY GORHAM

MEDICARE: TIMOTHY GORHAM
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1922505700
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY GORHAM
Provider Business Mailing Address
First Line : 1006 KEYSTONE DR
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44121-2443
Country : US
Telephone Number : 330-554-9578
Fax Number :
Provider Business Practice Location Address
First Line : 3100 E 45TH ST STE 314
Second Line :
City : CLEVELAND
State : OH
Zip : 44127-1095
Country : US
Telephone Number : 216-441-9622
Fax Number : 888-460-4717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2018
Last Update Date : 04/09/2018

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Directions to “ TIMOTHY GORHAM ” Practice Location

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