1174642359 NPI number — RICK GEMMA, D.O., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174642359 NPI number — RICK GEMMA, D.O., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICK GEMMA, D.O., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1174642359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 WARRENSVILLE CENTER RD
Provider Second Line Business Mailing Address:
#202
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-7024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-561-3838
Provider Business Mailing Address Fax Number:
216-561-3003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 WARRENSVILLE CENTER RD
Provider Second Line Business Practice Location Address:
#202
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-7024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-561-3838
Provider Business Practice Location Address Fax Number:
216-561-3003
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEMMA
Authorized Official First Name:
RICK
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
216-561-3838

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  34007743G , 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)

  • Identifier: 25842 . This is a "QUAL CHOICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7875520 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000334087 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2443074 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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