Provider Demographics
NPI:1568420552
Name:DISA, JANE S (DO)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:S
Last Name:DISA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 SPRINGSIDE DR
Mailing Address - Street 2:#100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4110 WARRENSVILLE CENTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7024
Practice Address - Country:US
Practice Address - Phone:216-491-7036
Practice Address - Fax:216-491-7776
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006034174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
110201035OtherRAILROAD MEDICARE
OH0967539Medicaid
OHG11935Medicare UPIN
OH0789233Medicare PIN