Provider Demographics
NPI:1598821696
Name:MEDLING, JAMES M (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:MEDLING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7057 W 130TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7841
Mailing Address - Country:US
Mailing Address - Phone:440-842-2222
Mailing Address - Fax:440-842-5547
Practice Address - Street 1:7057 W 130TH ST STE 201
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7841
Practice Address - Country:US
Practice Address - Phone:440-842-2222
Practice Address - Fax:440-842-5547
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3081103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP22061Medicare PIN