Healthcare Provider Details

I. General information

NPI: 1033031489
Provider Name (Legal Business Name): ABDUL MANAN DERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4757 LORAIN AVE
CLEVELAND OH
44102-3442
US

IV. Provider business mailing address

2500 METROHEALTH DR
CLEVELAND OH
44109-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-696-3876
  • Fax: 216-957-2404
Mailing address:
  • Phone: 216-778-4612
  • Fax: 216-957-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57.260671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: