Provider Demographics
NPI:1720049810
Name:REZA, MOHAMMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:
Last Name:REZA
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:PO BOX 450923
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0621
Mailing Address - Country:US
Mailing Address - Phone:444-333-5767
Mailing Address - Fax:440-333-5768
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SUITE T04
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-333-5767
Practice Address - Fax:440-333-5768
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076235207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH04 06811OtherEVERCARE
WV3810004119Medicaid
OH300230243026OtherCARESOURCE
OH2177522Medicaid
OH000000333406OtherANTHEM
OH91894OtherQUALCHOICE
OHF76235OtherSUMMACARE
OH04 06811OtherEVERCARE
OHRE4021045Medicare ID - Type Unspecified
WV3810004119Medicaid