Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 35-034111 | OH |
N | 208000000X | Pediatrician | 35-034111 | OH |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 35-034111 | OH |
NPI | 1124137476 |
---|---|
Provider Name | Avroy A Fanaroff |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 05/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000028185 | ANTHEM (01) | OH |
000000221252 | UNISON (01) | OH |
0182556 | (05) | OH |
0182556 | BCMH (01) | OH |
363519 | WELLCARE (01) | OH |
400722 | AETNA (01) | OH |
745905 | BUCKEYE (01) | OH |
A83653 | (02) | OH |