Basic Information
Provider Information | |||||||||
NPI: | 1558389239 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FURMAN | ||||||||
FirstName: | LYDIA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PETER | ||||||||
OtherFirstName: | LYDIA | ||||||||
OtherMiddleName: | FURMAN | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 11100 EUCLID AVE RM 784 | ||||||||
Address2: |   | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441061716 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2168448260 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11100 EUCLID AVE | ||||||||
Address2: |   | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441061716 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2168447700 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/18/2006 | ||||||||
LastUpdateDate: | 12/17/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/17/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35-059511 | OH | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 35059511 | OH | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 000000027286 | 01 | OH | ANTHEM | OTHER | 0639106 | 01 | OH | AETNA | OTHER | 1018884680001 | 05 | PA |   | MEDICAID | 000000526046 | 01 | OH | ANTHEM | OTHER | 363540 | 01 | OH | WELLCARE | OTHER | AETNA | 01 | OH | 639106 | OTHER | 238052 | 01 | OH | BUCKEYE | OTHER | 000000221169 | 01 | OH | UNISON | OTHER | 0776987 | 01 | OH | BCMH | OTHER | 0776987 | 05 | OH |   | MEDICAID |