Provider Demographics
NPI:1598841835
Name:EUCLID PEDIATRICS INC
Entity Type:Organization
Organization Name:EUCLID PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-261-2606
Mailing Address - Street 1:26250 EUCLID AVE
Mailing Address - Street 2:STE 611
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3305
Mailing Address - Country:US
Mailing Address - Phone:216-261-2606
Mailing Address - Fax:216-261-9814
Practice Address - Street 1:7200 CENTER ST
Practice Address - Street 2:STE 200
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4900
Practice Address - Country:US
Practice Address - Phone:440-255-0706
Practice Address - Fax:440-255-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2066964Medicaid