Provider Demographics
NPI:1558325647
Name:WINE, ALAN CECIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CECIL
Last Name:WINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3619 PARK EAST DR
Mailing Address - Street 2:SUITE 211 SOUTH
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4330
Mailing Address - Country:US
Mailing Address - Phone:216-378-0900
Mailing Address - Fax:216-378-1853
Practice Address - Street 1:3619 PARK EAST DR
Practice Address - Street 2:SUITE 211 SOUTH
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-4330
Practice Address - Country:US
Practice Address - Phone:216-378-0900
Practice Address - Fax:216-378-1853
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-032845207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304585Medicaid
C-00981Medicare UPIN
OH0374315Medicare ID - Type Unspecified
OH0304585Medicaid