Provider Demographics
NPI:1679570741
Name:KAPLAN, JEFFREY MARK (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:KAPLAN
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 1:23625 COMMERCE PARK
Mailing Address - Street 2:#204
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5845
Mailing Address - Country:US
Mailing Address - Phone:216-255-5725
Mailing Address - Fax:866-618-2917
Practice Address - Street 1:398 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-2016
Practice Address - Country:US
Practice Address - Phone:216-255-5725
Practice Address - Fax:866-618-2917
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME831342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808187700Medicaid
PA102324628 0001Medicaid
NY00193664Medicaid
KY7100078610Medicaid
NC7617022Medicaid
FL000576200Medicaid
OH2771193Medicaid
OH2763997Medicaid
IN200933260Medicaid
OH2763997Medicaid
PA102324628 0001Medicaid
NC7617022Medicaid
FL000576200Medicaid
ID808187700Medicaid
NY00193664Medicaid