Individual
RICHARD W. PINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1730 W 25TH ST, CLEVELAND, OH 44113-3108
(216) 696-4300
Mailing address
4356 DIANA DR, BROADVIEW HTS, OH 44147-2114
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
35037392
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0492319
—
OH
01
—
942460636414
CARESOURCE
OH
Enumeration date
05/28/2006
Last updated
07/08/2007
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