Provider Demographics
NPI:1134201825
Name:EMANCIPATOR, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:EMANCIPATOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 WARRENSVILLE CTR RD
Mailing Address - Street 2:MSC 9152
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-286-6299
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34047991207ZI0100X
OH35047991207ZP0101X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH363507OtherWELLCARE
OH000000528747OtherANTHEM
OH0498546Medicaid
OH750544OtherBUCKEYE
OH0639660OtherAETNA
OH341794737008OtherMMO
OH000000030170OtherANTHEM
OH000000224364OtherUNISON
OH639660OtherAETNA
OHA15283Medicare UPIN
OH000000030170OtherANTHEM
OH363507OtherWELLCARE