Provider Demographics
NPI:1689754178
Name:ROOT, MARGARET (AA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 CARNEGIE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3016
Mailing Address - Country:US
Mailing Address - Phone:216-928-0136
Mailing Address - Fax:
Practice Address - Street 1:10515 CARNEGIE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3016
Practice Address - Country:US
Practice Address - Phone:216-928-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000022367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000375437OtherANTHEM
OH2265089Medicaid
OH8222811Medicare ID - Type Unspecified