Individual
AVROY A FANAROFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-7700
(440) 449-1555
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35-034111
OH
207LP3000X
Pediatric Anesthesiology Physician
35-034111
OH
208000000X
Pediatrics Physician
35-034111
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35-034111
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028185
ANTHEM
OH
01
—
000000221252
UNISON
OH
01
—
0182556
BCMH
OH
05
—
0182556
—
OH
01
—
363519
WELLCARE
OH
01
—
400722
AETNA
OH
01
—
745905
BUCKEYE
OH
Enumeration date
08/30/2006
Last updated
07/05/2011
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