Provider Demographics
NPI:1871560300
Name:MERVART, MILOSLAVA A (MD)
Entity type:Individual
Prefix:
First Name:MILOSLAVA
Middle Name:A
Last Name:MERVART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71313
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0001
Mailing Address - Country:US
Mailing Address - Phone:440-835-3883
Mailing Address - Fax:440-899-2299
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:#330
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-835-3883
Practice Address - Fax:440-899-2299
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694495Medicaid
C03304Medicare UPIN
OH7313701Medicare PIN