Provider Demographics
NPI:1053558478
Name:DAVID P AGLE MD INC
Entity type:Organization
Organization Name:DAVID P AGLE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:AGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-844-3431
Mailing Address - Street 1:10524 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-2205
Mailing Address - Country:US
Mailing Address - Phone:216-844-3431
Mailing Address - Fax:216-844-4741
Practice Address - Street 1:10524 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2205
Practice Address - Country:US
Practice Address - Phone:216-844-3431
Practice Address - Fax:216-844-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0313495Medicaid
OH9392041Medicare PIN
OHA14614Medicare UPIN