Provider Demographics
NPI:1992797989
Name:RIBOVICH, MARTIN L (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:RIBOVICH
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 1:5260 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-1747
Mailing Address - Country:US
Mailing Address - Phone:216-286-6295
Mailing Address - Fax:216-286-6341
Practice Address - Street 1:41201 SCHADDEN RD
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2220
Practice Address - Country:US
Practice Address - Phone:440-324-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350698922085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000529634OtherANTHEM
OH363951OtherWELLCARE
OH2017598Medicaid
OH5461490OtherAETNA
OH732807OtherBUCKEYE
OH000000224148OtherUNISON
OH732807OtherBUCKEYE
OHRI0824176Medicare PIN
OHRI0824178Medicare PIN
OH363951OtherWELLCARE
OHRI0824175Medicare PIN
OH000000529634OtherANTHEM
OH5461490OtherAETNA