Provider Demographics
NPI:1548228687
Name:JAHDI, ELOISA H (MD)
Entity Type:Individual
Prefix:
First Name:ELOISA
Middle Name:H
Last Name:JAHDI
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 1:19250 BAGLEY RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3347
Mailing Address - Country:US
Mailing Address - Phone:440-627-2040
Mailing Address - Fax:440-826-1910
Practice Address - Street 1:19250 BAGLEY RD
Practice Address - Street 2:STE 101
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3347
Practice Address - Country:US
Practice Address - Phone:440-627-2040
Practice Address - Fax:440-826-1910
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056010207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0817870Medicaid
OH0645542Medicare PIN
E98919Medicare UPIN