Provider Demographics
NPI:1285727164
Name:MAHLAY, TARAS (MD)
Entity type:Individual
Prefix:
First Name:TARAS
Middle Name:
Last Name:MAHLAY
Suffix:
Gender:M
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 74624
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0707
Mailing Address - Country:US
Mailing Address - Phone:440-816-2777
Mailing Address - Fax:440-816-5437
Practice Address - Street 1:14200 RIDGE RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-4975
Practice Address - Country:US
Practice Address - Phone:440-582-9600
Practice Address - Fax:440-582-5492
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35061578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17812Medicare UPIN