Provider Demographics
NPI:1689762015
Name:EPSTEIN, DONALD LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LESLIE
Last Name:EPSTEIN
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 1:1450 SOM CENTER ROAD
Mailing Address - Street 2:28
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-684-9500
Mailing Address - Fax:440-684-1115
Practice Address - Street 1:1450 SOM CENTER RD
Practice Address - Street 2:#28
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-684-9500
Practice Address - Fax:440-684-1115
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040595207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
81013OtherAUAH CHOICE
000000130982OtherANTHEM
34136326900OtherBWC
OH0355806Medicaid
341363269001OtherTRICARE
000000130982OtherANTHEM
34136326900OtherBWC