Provider Demographics
NPI: | 1003812488 |
---|---|
Name: | LAYE, PETER M (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | PETER |
Middle Name: | M |
Last Name: | LAYE |
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: | 2500 METROHEALTH DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CLEVELAND |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44109-1900 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 216-778-7800 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2500 METROHEALTH DR |
Practice Address - Street 2: | |
Practice Address - City: | CLEVELAND |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44109-1900 |
Practice Address - Country: | US |
Practice Address - Phone: | 216-778-7800 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-22 |
Last Update Date: | 2021-12-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35060850L | 2085R0001X |
PA | MD072499L | 2085R0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0018515000001 | Medicaid | |
OH | 0965620 | Medicaid | |
OH | 0741794 | Medicare PIN | |
F65268 | Medicare UPIN | ||
PA | 920005873 | Medicare PIN | |
OH | 0741793 | Medicare PIN | |
PA | 042993 | Medicare PIN | |
OH | 0965620 | Medicaid |