Provider Demographics
NPI:1740205350
Name:BRELL, JOANNA M (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:BRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-1239
Mailing Address - Country:US
Mailing Address - Phone:216-402-9158
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:MEDICAL STAFF OFFICE ROOM A109
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109
Practice Address - Country:US
Practice Address - Phone:216-778-5790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-066467207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
363379OtherWELLCARE
000000224249OtherUNISON
000000539535OtherANTHEM
OH0981899Medicaid
OHP00425398OtherRAILROAD MEDICARE
OH2529728OtherAETNA
741814OtherBUCKEYE
000000224249OtherUNISON
OHBR4044971Medicare PIN
000000539535OtherANTHEM
OH0981899Medicaid