Healthcare Provider Details

I. General information

NPI: 1093270969
Provider Name (Legal Business Name): MR. ADAM FARAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2019
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 S ARLINGTON RD
AKRON OH
44312
US

IV. Provider business mailing address

2818 SOUTH ARLINGTON RD
AKRON OH
44312
US

V. Phone/Fax

Practice location:
  • Phone: 330-645-0148
  • Fax:
Mailing address:
  • Phone: 330-645-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02190226
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: