Provider Demographics
NPI:1255519807
Name:HOWARD WAXMAN
Entity type:Organization
Organization Name:HOWARD WAXMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WAXMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:440-546-5656
Mailing Address - Street 1:35000 CHARDON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9019
Mailing Address - Country:US
Mailing Address - Phone:440-571-5515
Mailing Address - Fax:440-571-5537
Practice Address - Street 1:7976 BROADVIEW RD STE 100
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-1268
Practice Address - Country:US
Practice Address - Phone:440-546-5656
Practice Address - Fax:440-546-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002098332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1076280001Medicare NSC