Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 31453 | SC |
Y | 207RH0003X | Hematology & Oncology | 35.097580 | OH |
N | 207RX0202X | Medical Oncology | 31453 | SC |
NPI | 1104960525 |
---|---|
Provider Name | Dr. Prateek Mendiratta |
First Address | Beachwood, OH 44122-1191 |
Second Address | Beachwood, OH 44122-1191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2007 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AA3838 | (02) | SC |
H013360 | (02) | OH |