Provider Demographics
NPI:1972589760
Name:LENAMOND, CARRIE (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LENAMOND
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 1:5700 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:330-656-9304
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:44 BLAINE AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2709
Practice Address - Country:US
Practice Address - Phone:440-735-3900
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086336207P00000X
TXM7369207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AB541OtherBCBS OF TEXAS
TX0079QROtherBCBS
OH2578107Medicaid
TX191340201Medicaid
TXP00472947OtherRAILROAD MEDICARE
I24724Medicare UPIN
TX0079QROtherBCBS
TX8K1219Medicare PIN
OHST4162561Medicare ID - Type Unspecified