Provider Demographics
NPI:1972695559
Name:NEMEC, CAROLYN F (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:F
Last Name:NEMEC
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 1:29001 CEDAR RD STE 655
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4041
Mailing Address - Country:US
Mailing Address - Phone:440-249-4455
Mailing Address - Fax:
Practice Address - Street 1:29001 CEDAR RD STE 655
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-4041
Practice Address - Country:US
Practice Address - Phone:440-249-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH54557207Q00000X
OH35054557N207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0681481Medicaid
OH0681481Medicaid