Individual
JONATHAN M 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
(216) 286-6341
Mailing address
24701 EUCLID AVE, 3RD FLOOR, EUCLID, OH 44117-1714
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
35-081809
OH
207LP3000X
Pediatric Anesthesiology Physician
35-081809
OH
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
35-081809
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000221320
UNISON
OH
01
—
000000257656
ANTHEM
OH
01
—
000000525952
ANTHEM
OH
01
—
1017390000001
PA MEDICAID
OH
01
—
2372105
BCMH
OH
05
—
2372105
—
OH
01
—
363518
WELLCARE
OH
01
—
733798
BUCKEYE
OH
01
—
7914428
AETNA
OH
Enumeration date
07/18/2006
Last updated
07/05/2011
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