Provider Demographics
NPI:1073512273
Name:PETERMAN, ARKADY (MD,)
Entity type:Individual
Prefix:
First Name:ARKADY
Middle Name:
Last Name:PETERMAN
Suffix:
Gender:
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 FOX HOLLOW DR APT 403
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4173
Mailing Address - Country:US
Mailing Address - Phone:440-840-5289
Mailing Address - Fax:
Practice Address - Street 1:27801 EUCLID AVE STE 100
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3547
Practice Address - Country:US
Practice Address - Phone:440-840-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235143207R00000X
OH35.091234207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02633443Medicaid
NYRA6517Medicare ID - Type Unspecified
NY02633443Medicaid