Provider Demographics
NPI:1336179647
Name:ABASHIDZE, TEAH (MD)
Entity Type:Individual
Prefix:DR
First Name:TEAH
Middle Name:
Last Name:ABASHIDZE
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 1:1831 FOREST HILLS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:E CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4348
Mailing Address - Country:US
Mailing Address - Phone:216-541-3600
Mailing Address - Fax:
Practice Address - Street 1:4758 RIDGE RD
Practice Address - Street 2:SUITE 161
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-3327
Practice Address - Country:US
Practice Address - Phone:440-236-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083950A207R00000X
MDD76164208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2531460Medicaid
OH9351811Medicare ID - Type Unspecified
OH2531460Medicaid