Provider Demographics
NPI:1043937022
Name:GOLPHIN, LONDON
Entity Type:Individual
Prefix:
First Name:LONDON
Middle Name:
Last Name:GOLPHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10735 RAVENNA RD
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3107
Mailing Address - Country:US
Mailing Address - Phone:234-212-1100
Mailing Address - Fax:
Practice Address - Street 1:10735 RAVENNA RD STE 206
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-3107
Practice Address - Country:US
Practice Address - Phone:234-212-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator