Provider Demographics
NPI:1316155989
Name:STEFANO, GREGORY THOMAS (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:STEFANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR - BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-358-5480
Mailing Address - Fax:440-358-5481
Practice Address - Street 1:7500 AUBURN RD STE 1500
Practice Address - Street 2:HARRINGTON HEART & VASCULAR INSTITUTE
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9613
Practice Address - Country:US
Practice Address - Phone:440-358-5480
Practice Address - Fax:440-358-5481
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.009621207R00000X
OH35-090204207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2776536Medicaid
OHH089501Medicare PIN