Provider Demographics
NPI:1386697621
Name:WEST SIDE CARDIOLOGY ASSOC., INC.
Entity type:Organization
Organization Name:WEST SIDE CARDIOLOGY ASSOC., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCELLO
Authorized Official - Middle Name:M
Authorized Official - Last Name:MELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-8600
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-333-8600
Mailing Address - Fax:440-333-5015
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-333-8600
Practice Address - Fax:440-333-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0946776Medicaid
OH9916161Medicare PIN