Provider Demographics
NPI:1194035378
Name:TASS, BRITTANY BODE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:BODE
Last Name:TASS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:JANE
Other - Last Name:BODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:COR6097
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-1644
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:COR6097
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.003625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics