Provider Demographics
NPI:1023131125
Name:DAVIDSON, ELEANOR WARNOCK (MD)
Entity type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:WARNOCK
Last Name:DAVIDSON
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 1:10900 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-4901
Mailing Address - Country:US
Mailing Address - Phone:216-368-6150
Mailing Address - Fax:216-368-8530
Practice Address - Street 1:10900 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-4901
Practice Address - Country:US
Practice Address - Phone:216-368-6150
Practice Address - Fax:216-368-8530
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-052336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0636842Medicaid
OH35-052336OtherSTATE MEDICAL BOARD LICEN
OH0636842Medicaid