Provider Demographics
NPI:1720195811
Name:MARIAPPURAM, VALSA JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:VALSA
Middle Name:JOSE
Last Name:MARIAPPURAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALSAMMA
Other - Middle Name:JOSE
Other - Last Name:MARIAPPURAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE AVE E
Mailing Address - Street 2:#1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 SEVERANCE CIR
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1533
Practice Address - Country:US
Practice Address - Phone:216-524-7377
Practice Address - Fax:216-297-2542
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061070207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0164816Medicaid
MA0719971Medicare ID - Type Unspecified
OH0164816Medicaid