1538323845 NPI number — DR. REVITAL LEAH GORODESKI BASKIN M.D.

Table of content: DR. REVITAL LEAH GORODESKI BASKIN M.D. (NPI 1538323845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538323845 NPI number — DR. REVITAL LEAH GORODESKI BASKIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORODESKI BASKIN
Provider First Name:
REVITAL
Provider Middle Name:
LEAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GORODESKI
Provider Other First Name:
REVITAL
Provider Other Middle Name:
LEAH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538323845
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPARTMENT OF ENDOCRINOLOGY CLEVELAND CLINIC
Provider Second Line Business Mailing Address:
9500 EUCLID AVENUE
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44195-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-445-3784
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF ENDOCRINOLOGY CLEVELAND CLINIC
Provider Second Line Business Practice Location Address:
9500 EUCLID AVENUE
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44195-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-445-3784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2008

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: 390200000X , with the licence number:  35091030 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 35.091752 , 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)