Basic Information
| Provider Information | |||||||||
| NPI: | 1992797989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIBOVICH | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5260 SMITH RD | ||||||||
| Address2: | |||||||||
| City: | BROOKPARK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441421747 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2162866295 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Practice Location | |||||||||
| Address1: | 41201 SCHADDEN RD | ||||||||
| Address2: | |||||||||
| City: | ELYRIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440352220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403240440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 03/12/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35069892 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 000000529634 | 01 | OH | ANTHEM | OTHER | 363951 | 01 | OH | WELLCARE | OTHER | 2017598 | 05 | OH | MEDICAID | 5461490 | 01 | OH | AETNA | OTHER | 732807 | 01 | OH | BUCKEYE | OTHER | 000000224148 | 01 | OH | UNISON | OTHER |