Provider Demographics
NPI:1710924113
Name:THYNNE, A. MERVYN (MD)
Entity Type:Individual
Prefix:
First Name:A.
Middle Name:MERVYN
Last Name:THYNNE
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 1:25001 EMERY RD
Mailing Address - Street 2:100
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5621
Mailing Address - Country:US
Mailing Address - Phone:216-831-9786
Mailing Address - Fax:216-831-2425
Practice Address - Street 1:25001 EMERY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5621
Practice Address - Country:US
Practice Address - Phone:216-831-9786
Practice Address - Fax:216-831-2425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0426652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0424651Medicaid
OH0424651Medicaid
OHTH0506447Medicare ID - Type Unspecified