Provider Demographics
NPI:1376719484
Name:NORTH COAST PEDIATRICS
Entity Type:Organization
Organization Name:NORTH COAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:K
Authorized Official - Last Name:ABRAHAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-356-2272
Mailing Address - Street 1:20800 WESTGATE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-1323
Mailing Address - Country:US
Mailing Address - Phone:440-356-2272
Mailing Address - Fax:440-356-2299
Practice Address - Street 1:20800 WESTGATE
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-1323
Practice Address - Country:US
Practice Address - Phone:440-356-2272
Practice Address - Fax:440-356-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2207650Medicaid