Provider Demographics
NPI:1376816330
Name:KOOMSON, GLORIA J (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:J
Last Name:KOOMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2082 WINDHAM ST NE STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2528
Mailing Address - Country:US
Mailing Address - Phone:330-361-0329
Mailing Address - Fax:
Practice Address - Street 1:14243 TRISKETT RD
Practice Address - Street 2:APT 203K
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-2329
Practice Address - Country:US
Practice Address - Phone:216-200-1791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA175239208M00000X
OH35133932207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist