Provider Demographics
NPI:1124133483
Name:EWING-WILSON, DEBORAH LOUISE (DO)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LOUISE
Last Name:EWING-WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 COMMONS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-4103
Mailing Address - Country:US
Mailing Address - Phone:330-954-7233
Mailing Address - Fax:216-201-4620
Practice Address - Street 1:8819 COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-4101
Practice Address - Country:US
Practice Address - Phone:330-954-7233
Practice Address - Fax:216-201-4620
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0037342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0895689Medicaid
OH0895689Medicaid
E97112Medicare UPIN