Provider Demographics
NPI:1518919414
Name:JHAVERI, STACIE A (MD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:A
Last Name:JHAVERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STASIA
Other - Middle Name:A
Other - Last Name:JHAVERI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:24700 LORAIN RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2088
Mailing Address - Country:US
Mailing Address - Phone:440-777-5660
Mailing Address - Fax:440-777-7036
Practice Address - Street 1:24700 LORAIN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2088
Practice Address - Country:US
Practice Address - Phone:440-777-5660
Practice Address - Fax:440-777-7036
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071975207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2074722Medicaid
OH4249101Medicare PIN
OH2074722Medicaid
OH7278011Medicare PIN