Provider Demographics
NPI:1598850042
Name:DORSKY, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:DORSKY
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 1:20775 S. WOODLAND RD.
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS.
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3011
Mailing Address - Country:US
Mailing Address - Phone:440-536-6759
Mailing Address - Fax:216-751-0206
Practice Address - Street 1:3025 SCIENCE PARK DR
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7333
Practice Address - Country:US
Practice Address - Phone:216-455-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054025208D00000X
OH35054025D208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0643503Medicaid
OHA16533Medicare UPIN