1598850661 NPI number — KATHLEEN M FINNEGAN PHD

Table of content: KATHLEEN M FINNEGAN PHD (NPI 1598850661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598850661 NPI number — KATHLEEN M FINNEGAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINNEGAN
Provider First Name:
KATHLEEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1598850661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3872 E HARBOR LIGHT LANDING DR
Provider Second Line Business Mailing Address:
SUITE 316
Provider Business Mailing Address City Name:
PORT CLINTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43452-3877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-734-3333
Provider Business Mailing Address Fax Number:
877-734-2030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3619 PARK EAST DR
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-4330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-591-0500
Provider Business Practice Location Address Fax Number:
216-591-0550
Provider Enumeration Date:
10/04/2006

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: 103TC0700X , with the licence number:  5020 , 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: 000000137844 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0182369 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 294505000 . This is a "MAGELLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 620003454 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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