Provider Demographics
NPI:1871529321
Name:NORTH COAST NEPHROLOGY, INC
Entity type:Organization
Organization Name:NORTH COAST NEPHROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FAWZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-323-3574
Mailing Address - Street 1:1170 E BROAD ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6351
Mailing Address - Country:US
Mailing Address - Phone:440-323-3574
Mailing Address - Fax:440-323-3552
Practice Address - Street 1:1170 E BROAD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6351
Practice Address - Country:US
Practice Address - Phone:440-323-3574
Practice Address - Fax:440-323-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582610Medicaid
OH2582610Medicaid