Healthcare Provider Details

I. General information

NPI: 1881604817
Provider Name (Legal Business Name): MITCHEL L FROMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AKRON GENERAL AVE
AKRON OH
44307-2432
US

IV. Provider business mailing address

122 N HAYDEN PKWY
HUDSON OH
44236-3152
US

V. Phone/Fax

Practice location:
  • Phone: 330-384-6448
  • Fax: 330-344-6512
Mailing address:
  • Phone: 330-650-6073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number053642
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number35.053642
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: