Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 35-076430 | OH |
N | 208000000X | Pediatrician | 35076430 | OH |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 35076430 | OH |
NPI | 1003805508 |
---|---|
Provider Name | Mary Nock |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 06/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000221257 | UNISON (01) | OH |
000000526112 | ANTHEM (01) | OH |
1018331740001 | PA MEDICAID (01) | PA |
2195360 | (05) | OH |
2195360 | BCMH (01) | OH |
363880 | WELLCARE (01) | OH |
7336138 | AETNA (01) | OH |
745959 | BUCKEYE (01) | OH |
H17681 | (02) |