| Doctor Name: | JEROME NGANGANA |
| NPI Number: | 1598750705 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 35073902 |
| Business Practice Address: | 29000 Center Ridge Rd St John West Shore Hospital Westlake, OH - 441455293 |
| Business Phone Number: | 4408358000 |
| Business Fax Number: | |
| Mailing Address: | 30680 Bainbridge Rd, Northeast Ohio Group Practice CLEVELAND |
| State: | OH |
| Postal Code: | 441392282 |
| Phone Number: | 4405425023 |
| Fax Number: | 4405425029 |
| NPI Enumeration Date: | 09/14/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 35073902 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |