Provider Demographics
NPI:1366462749
Name:REISMAN, ALLEN TONY (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:TONY
Last Name:REISMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:REISMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-2200
Mailing Address - Fax:
Practice Address - Street 1:26900 CEDAR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-1191
Practice Address - Country:US
Practice Address - Phone:216-839-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-070883207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000206512OtherUNISON
OH000000506211OtherANTHEM
OH2108936Medicaid
OH363943OtherWELLCARE
OH738088OtherBUCKEYE
OHP00358773OtherRAILROAD MEDICARE
OH000000132432OtherANTHEM
OH5835703OtherAETNA
OH000000132432OtherANTHEM
OH000000506211OtherANTHEM
OH738088OtherBUCKEYE