Provider Demographics
NPI:1770759805
Name:WATERS, TINA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:ELIZABETH
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:FA20
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-2165
Mailing Address - Fax:216-445-6205
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:FA20
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-2165
Practice Address - Fax:216-445-6205
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0930262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology