Provider Demographics
NPI:1124057716
Name:MCCREERY, LAURIE S (MD, PHD, MA)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:S
Last Name:MCCREERY
Suffix:
Gender:F
Credentials:MD, PHD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 METROHEALTH DRIVE
Mailing Address - Street 2:MHMC MEDICINE INTERNAL MEDICINE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:216-778-5048
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DRIVE
Practice Address - Street 2:MHMC MEDICINE INTERNAL MEDICINE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-5048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1038718000OtherBWC
OHMC7273981Medicare ID - Type Unspecified
OH1038718000OtherBWC