Provider Demographics
NPI:1962487819
Name:GARLISI, ANDREW P (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:GARLISI
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 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:13207 RAVENNA RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-7032
Practice Address - Country:US
Practice Address - Phone:440-285-6000
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070392207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH930121866OtherRAILROAD MEDICARE
OH2011049Medicaid
OH4174489OtherMEDICARE
OHN379478OtherWELLCARE
OH102020678-0001OtherPENNSYLVANIA MEDICAID
OHP00347156OtherRAILROAD MEDICARE
OH000000358818OtherANTHEM
OHP00330793OtherRAILROAD MEDICARE
OHP00330793OtherRAILROAD MEDICARE
OHGA0835108Medicare PIN
OHGA4174483Medicare PIN
OH4174489Medicare UPIN
OHD21420Medicare UPIN
OH2011049Medicaid
OH102020678-0001OtherPENNSYLVANIA MEDICAID
OHP00347156OtherRAILROAD MEDICARE
OH4174489Medicare Oscar/Certification
OHGA0835109Medicare PIN
OH930121866OtherRAILROAD MEDICARE