Provider Demographics
NPI:1649446634
Name:DONALD E EGHOBAMIEN M.D INC.
Entity type:Organization
Organization Name:DONALD E EGHOBAMIEN M.D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:EGHOBAMIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-861-6200
Mailing Address - Street 1:4758 RIDGE RD
Mailing Address - Street 2:#161
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3327
Mailing Address - Country:US
Mailing Address - Phone:440-235-8484
Mailing Address - Fax:440-235-8440
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:SUITE 320
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:440-235-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH44619Medicare UPIN
OHDO9375391Medicare PIN