Provider Demographics
NPI:1205803665
Name:NEMR, GASAN (MD)
Entity type:Individual
Prefix:
First Name:GASAN
Middle Name:
Last Name:NEMR
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 1:24651 CENTER RIDGE RD
Mailing Address - Street 2:STE 350
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5627
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:15000 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107
Practice Address - Country:US
Practice Address - Phone:216-221-7642
Practice Address - Fax:216-529-7806
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082501N207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11059884OtherCAQH
1780634279OtherGROUP NPI
0119204OtherGROUP MEDICAID
103872OtherKAISER
9273172OtherGROUP MEDICARE
3610861OtherGROUP ASC MEDICARE
CA4511OtherRR MEDICARE GROUP
D368301OtherGROUP IND DIAGNOSTICS MED
OH2422373Medicaid
P00035659OtherRR MEDICARE INDIVIDUAL
1780634279OtherGROUP NPI
CA4511OtherRR MEDICARE GROUP
9273172OtherGROUP MEDICARE