Provider Demographics
NPI:1538323845
Name:GORODESKI BASKIN, REVITAL LEAH (MD)
Entity Type:Individual
Prefix:DR
First Name:REVITAL
Middle Name:LEAH
Last Name:GORODESKI BASKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REVITAL
Other - Middle Name:LEAH
Other - Last Name:GORODESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:DEPARTMENT OF ENDOCRINOLOGY CLEVELAND CLINIC
Mailing Address - Street 2:9500 EUCLID AVENUE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-3784
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF ENDOCRINOLOGY CLEVELAND CLINIC
Practice Address - Street 2:9500 EUCLID AVENUE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-3784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091030390200000X
OH35.091752207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program