Provider Demographics
NPI:1093987299
Name:DEA, EDWARD (RAC, LAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:DEA
Suffix:
Gender:M
Credentials:RAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2937 HAMPSHIRE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118
Mailing Address - Country:US
Mailing Address - Phone:216-647-2486
Mailing Address - Fax:
Practice Address - Street 1:2460 FAIRMOUNT BLVD, HEIGHTS MEDICAL BLDG., SUITE #324
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-647-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000.115171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist