Provider Demographics
NPI:1073502589
Name:SIMMONS, EDWINA E (MD)
Entity Type:Individual
Prefix:
First Name:EDWINA
Middle Name:E
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5635
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:7225 OLD OAK BLVD
Practice Address - Street 2:SUITE B311
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3339
Practice Address - Country:US
Practice Address - Phone:440-895-5056
Practice Address - Fax:440-333-2935
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00111439OtherRR MEDICARE
OH0703037Medicaid
OH0774838Medicare PIN
OHF38303Medicare UPIN
OH0703037Medicaid