Provider Demographics
NPI:1811972979
Name:MEEHAN-DE LA CRUZ, KATHLEEN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:ANN
Last Name:MEEHAN-DE LA CRUZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3600 KOLBE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-1652
Mailing Address - Country:US
Mailing Address - Phone:440-960-3954
Mailing Address - Fax:440-960-3956
Practice Address - Street 1:3600 KOLBE RD STE 120
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-1652
Practice Address - Country:US
Practice Address - Phone:440-960-3954
Practice Address - Fax:440-960-3956
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35094465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2998369Medicaid
NC8913247Medicaid
NCH02855Medicare UPIN
NC13247OtherBLUE CROSS BLUE SHIELD