Provider Demographics
NPI:1609941392
Name:BERISLAV SPAHIJA,M.D., INC.
Entity Type:Organization
Organization Name:BERISLAV SPAHIJA,M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAHIJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-382-1070
Mailing Address - Street 1:16687 SAINT CLAIR AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9401
Mailing Address - Country:US
Mailing Address - Phone:330-382-1070
Mailing Address - Fax:330-382-0916
Practice Address - Street 1:16687 SAINT CLAIR AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9401
Practice Address - Country:US
Practice Address - Phone:330-382-1070
Practice Address - Fax:330-382-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3580889208100000X
OH350772852084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500696OtherUNTED HEALTHCARE
218165OtherUPMC
130021621OtherRAILROAD MEDICARE
18076961300OtherMMOH
774691OtherBS PA
OH000000142099OtherANTHEM
1047518OtherWV COMP
OH2150390Medicaid
26386OtherINDIANA HEALTH PLAN
P77285OtherHEALTH PLAN
000520339OtherBC BS PA
95840OtherQUALCHOICE
2260699OtherAETNA
WV6120037-000Medicaid
130021621OtherRAILROAD MEDICARE
130021621OtherRAILROAD MEDICARE
OHH07699Medicare UPIN
18076961300OtherMMOH
218165OtherUPMC
WV6120037-000Medicaid