Provider Demographics
NPI:1417190281
Name:RALSTON, LAUREL ANN (DO)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:ANN
Last Name:RALSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932004
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0007
Mailing Address - Country:US
Mailing Address - Phone:216-363-2538
Mailing Address - Fax:216-694-4604
Practice Address - Street 1:2351 E 22ND ST STE AN114
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-363-2538
Practice Address - Fax:216-694-4604
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0103262084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry