Provider Demographics
NPI:1770544850
Name:WESTSHORE ADVANCED MEDICINE INC
Entity type:Organization
Organization Name:WESTSHORE ADVANCED MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:REZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-5767
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:440-274-5035
Mailing Address - Fax:440-260-6153
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3076406Medicaid
OH3076406Medicaid
OH3076406Medicaid
OH9343951Medicare PIN