Provider Demographics
NPI:1144205436
Name:GORJANC, MARY MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:GORJANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6900 PEARL RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3639
Mailing Address - Country:US
Mailing Address - Phone:440-292-1000
Mailing Address - Fax:440-292-1001
Practice Address - Street 1:15900 SNOW RD STE 300
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2860
Practice Address - Country:US
Practice Address - Phone:440-292-1000
Practice Address - Fax:440-292-1001
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-048000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0004558586OtherAETNA
OH2238206Medicaid
OH000000201141OtherANTHEM
OH0495307Medicaid
OH95357OtherQUAL CHOICE
OH000000201141OtherANTHEM
OH0640986Medicare PIN