Provider Demographics
NPI:1518197243
Name:CLEVELAND CLINIC FOUNDATION
Entity Type:Organization
Organization Name:CLEVELAND CLINIC FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMALADZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-513-0214
Mailing Address - Street 1:13700 FAIRHILL RD APT 401
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1275
Mailing Address - Country:US
Mailing Address - Phone:347-513-0214
Mailing Address - Fax:
Practice Address - Street 1:13700 FAIRHILL RD APT 401
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1275
Practice Address - Country:US
Practice Address - Phone:347-513-0214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAT441115282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital