Healthcare Provider Details

I. General information

NPI: 1740963867
Provider Name (Legal Business Name): AHDY ROFAEIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5209 EUCLID AVE
CLEVELAND OH
44103-3703
US

IV. Provider business mailing address

2029 E RESERVE CIR
AVON OH
44011-2819
US

V. Phone/Fax

Practice location:
  • Phone: 216-882-0765
  • Fax:
Mailing address:
  • Phone: 703-975-7135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number184064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: