1326144809 NPI number — PATRICIA J KELLNER MD

Table of content: PATRICIA J KELLNER MD (NPI 1326144809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326144809 NPI number — PATRICIA J KELLNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLNER
Provider First Name:
PATRICIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326144809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 901589
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44190-1589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-291-5454
Provider Business Mailing Address Fax Number:
216-291-5456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14100 CEDAR RD STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44121-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-383-0100
Provider Business Practice Location Address Fax Number:
216-383-6481
Provider Enumeration Date:
09/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35052063 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)