Provider Demographics
NPI:1053417709
Name:ANSEVIN, CARL (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:ANSEVIN
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 1:390 TIMBERIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040-9319
Mailing Address - Country:US
Mailing Address - Phone:216-554-5289
Mailing Address - Fax:
Practice Address - Street 1:390 TIMBERIDGE TRL
Practice Address - Street 2:
Practice Address - City:GATES MILLS
Practice Address - State:OH
Practice Address - Zip Code:44040-9319
Practice Address - Country:US
Practice Address - Phone:216-554-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH900972084N0400X
NMTM2015-07632084N0400X
GA749622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology