Individual
JACQUELYN D URBAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1730 W 25TH ST, CLEVELAND, OH 44113-3108
(216) 696-4300
Mailing address
16930 GLEN RD, MOUNT VERNON, OH 43050-9501
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
35049954
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0585915
—
OH
01
—
942460636052
CARESOURCE
OH
01
—
P00220796
MEDICARE TRAVELERS RR-GA
OH
Enumeration date
05/27/2006
Last updated
07/08/2007
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