Provider Demographics
NPI:1437252376
Name:FLYNN, STEPHEN P (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-5443
Mailing Address - Country:US
Mailing Address - Phone:216-281-8945
Mailing Address - Fax:216-961-5429
Practice Address - Street 1:3569 RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-5443
Practice Address - Country:US
Practice Address - Phone:216-281-8945
Practice Address - Fax:216-961-5429
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0729117Medicaid
AZ492906Medicaid
OH0729117Medicaid
OH7177521Medicare PIN