Provider Demographics
NPI:1831163112
Name:DAMM, WILLIAM ALFRED (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALFRED
Last Name:DAMM
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 1:16761 SOUTH PARK CRR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136
Mailing Address - Country:US
Mailing Address - Phone:440-878-2500
Mailing Address - Fax:440-878-3075
Practice Address - Street 1:16761 SOUTH PARK CRR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-878-2500
Practice Address - Fax:440-878-3075
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236248Medicaid
OH2142363Medicaid
OH2142363Medicaid
OH0883742Medicare ID - Type Unspecified
OH9284951Medicare PIN
OH0883744Medicare UPIN
OH0236248Medicaid