Provider Demographics
NPI:1861424160
Name:MOSTOW, NELSON D (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:D
Last Name:MOSTOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD STE C208
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3300
Mailing Address - Country:US
Mailing Address - Phone:440-816-2708
Mailing Address - Fax:440-243-8480
Practice Address - Street 1:7255 OLD OAK BLVD STE C208
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3300
Practice Address - Country:US
Practice Address - Phone:440-816-2708
Practice Address - Fax:440-243-8480
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039878207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100652OtherKAISER
OH2500531OtherUNITED HEALTHCARE
OH0434506Medicaid
OH69527OtherQUALCHOICE
OH000000132622OtherANTHEM BLUE CROSS/BLUE SH
OH4325239OtherAETNA
OHP39878OtherSUMMACARE
OH69527OtherQUALCHOICE
OH000000132622OtherANTHEM BLUE CROSS/BLUE SH
OH0434506Medicaid
OH0431169Medicare ID - Type Unspecified
OH4031001Medicare ID - Type Unspecified