Provider Demographics
NPI:1164477972
Name:HARLAN, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:HARLAN
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 1:10654 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5411
Mailing Address - Country:US
Mailing Address - Phone:216-941-1044
Mailing Address - Fax:216-941-5848
Practice Address - Street 1:10654 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5411
Practice Address - Country:US
Practice Address - Phone:216-941-1044
Practice Address - Fax:216-941-5848
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000353558OtherANTHEM BC/BS
OH351424OtherWELLCARE
OH0157468Medicaid
G04046Medicare UPIN
OH351424OtherWELLCARE
OH0886555Medicare PIN