Provider Demographics
NPI:1568507234
Name:NOTICEWALA, PENALI N (MD)
Entity Type:Individual
Prefix:
First Name:PENALI
Middle Name:N
Last Name:NOTICEWALA
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 1:9500 EUCLID AVE # G10
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-5549
Mailing Address - Fax:216-636-1524
Practice Address - Street 1:9500 EUCLID AVE # G10
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-5549
Practice Address - Fax:216-636-1524
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097675207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD932486-01 & 02OtherCAREFIRST - MD
MD415459200Medicaid
MDS062-0325OtherCAREFIRST - REGIONAL
MDP00630489Medicare PIN
MD130825Y1PMedicare PIN