Provider Demographics
NPI:1588612600
Name:MEDOFF, HERBERT I (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:I
Last Name:MEDOFF
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 1:5311 NORTH FIELD RD SUITE 310
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146
Mailing Address - Country:US
Mailing Address - Phone:216-475-0240
Mailing Address - Fax:216-663-8500
Practice Address - Street 1:5311 NORTH FIELD RD SUITE 310
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146
Practice Address - Country:US
Practice Address - Phone:216-475-0240
Practice Address - Fax:216-663-8500
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35023587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5851636Medicaid
A70406Medicare UPIN
OHME0119451Medicare ID - Type Unspecified