Provider Demographics
NPI:1578580510
Name:DEARBORN, DORR G (MD)
Entity Type:Individual
Prefix:
First Name:DORR
Middle Name:G
Last Name:DEARBORN
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0379102080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000525904OtherANTHEM
OH0559328Medicaid
OH363468OtherWELLLCARE
OH745898OtherBUCKEYE
OH000000221399OtherUNISON
OH0559328OtherBCMH
OH0639605OtherAETNA
OH370001912OtherRAILROAD MEDICARE
OH000000028322OtherANTHEM
OHA82466Medicare UPIN
OH370001912OtherRAILROAD MEDICARE
OH745898OtherBUCKEYE
OHDE0585234Medicare PIN
OHDE0585235Medicare PIN