Provider Demographics
NPI:1417979790
Name:LAWSON, DEBORAH A (AA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:LAWSON
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5203
Mailing Address - Country:US
Mailing Address - Phone:216-286-6260
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67-000040367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2739255Medicaid
OH000000515968OtherANTHEM
OH000000232167OtherUNISON
OH430038418OtherRAILROAD MEDICARE
OHP00383074OtherRAILROAD MEDICARE
OH7241401OtherAETNA
OH0583328OtherBCMH
OH414998OtherWELLCARE MEDICAID
OHLA8239341Medicare PIN
OH430038418OtherRAILROAD MEDICARE