Provider Demographics
NPI:1568857803
Name:ABBATEMARCO, JUSTIN RALPH (MD)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:RALPH
Last Name:ABBATEMARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # U10
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:216-210-9890
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # U10
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:216-636-0181
Practice Address - Fax:216-445-7013
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1294932084N0400X
UT11725371-12052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology