Individual
MARY NOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11100 EUCLID AVENUE, CLEVELAND, OH 44106
(216) 844-7700
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35-076430
OH
207LP3000X
Pediatric Anesthesiology Physician
35-076430
OH
208000000X
Pediatrics Physician
35076430
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35076430
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221257
UNISON
OH
01
—
000000526112
ANTHEM
OH
01
—
1018331740001
PA MEDICAID
PA
01
—
2195360
BCMH
OH
05
—
2195360
—
OH
01
—
363880
WELLCARE
OH
01
—
7336138
AETNA
OH
01
—
745959
BUCKEYE
OH
Enumeration date
10/18/2005
Last updated
07/06/2011
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