1831321397 NPI number — MRS. MARGUERITE SHERWIN FREDERICK LISW

Table of content: MRS. MARGUERITE SHERWIN FREDERICK LISW (NPI 1831321397)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831321397 NPI number — MRS. MARGUERITE SHERWIN FREDERICK LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREDERICK
Provider First Name:
MARGUERITE
Provider Middle Name:
SHERWIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHERWIN
Provider Other First Name:
MARGUERITE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LISW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831321397
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 MORNINGSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAGRIN FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44022-4234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-346-4101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11900 FAIRHILL RD.
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:
44120-1053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-791-8000
Provider Business Practice Location Address Fax Number:
121-637-3181
Provider Enumeration Date:
08/18/2009

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: 1041C0700X , with the licence number:  I0900050 , 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)





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