Provider Demographics
NPI:1912125428
Name:BAZELLA, CORINNE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:ANN
Last Name:BAZELLA
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:216-383-6950
Mailing Address - Fax:216-383-6749
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH89013207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000581366OtherANTHEM
MI1912125428Medicaid
OH467641OtherWELLCARE
9457103OtherAETNA
OH000000249530OtherUNISON
OH204881619914OtherCARESOURCE
OH2780905Medicaid
OHP00735174OtherRAILROAD MEDICARE
9457103OtherAETNA
MI1912125428Medicaid