Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35093484 | OH |
Y | 111NI0900X | Internist | 35093484 | OH |
NPI | 1003059197 |
---|---|
Provider Name | Dr. Anna Egriselashvili |
First Address | Mayfield Hts, OH 44124-2299 |
Second Address | Mayfield Hts, OH 44124-2299 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 05/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2998583 | (05) | OH |
4276311 | MEDICARE ID- TYPE UNSPECIFIED (01) | OH |