Provider Demographics
NPI:1396846358
Name:JAMES G EPSTEIN MD INC
Entity Type:Organization
Organization Name:JAMES G EPSTEIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-239-8737
Mailing Address - Street 1:PO BOX 241217
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS,
Mailing Address - State:OH
Mailing Address - Zip Code:44124-8817
Mailing Address - Country:US
Mailing Address - Phone:440-239-8737
Mailing Address - Fax:440-239-7811
Practice Address - Street 1:18660 BAGLEY RD
Practice Address - Street 2:STE 400B
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-8455
Practice Address - Country:US
Practice Address - Phone:440-239-8737
Practice Address - Fax:440-239-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049225E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDG3910OtherRAILROAD MEDICARE GROUP
OH36D1000944OtherCLIA
OHJA9316201Medicare PIN