Provider Demographics
NPI:1508858705
Name:GAMERMAN, LARISA LEONIDOVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:LARISA
Middle Name:LEONIDOVNA
Last Name:GAMERMAN
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 1:8254 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2593
Mailing Address - Country:US
Mailing Address - Phone:440-729-9000
Mailing Address - Fax:440-729-0519
Practice Address - Street 1:8254 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2593
Practice Address - Country:US
Practice Address - Phone:440-729-9000
Practice Address - Fax:440-729-0519
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625270Medicaid
OH000000364167OtherANTHEM
OHI33415Medicare UPIN
OH2625270Medicaid