Healthcare Provider Details

I. General information

NPI: 1003295221
Provider Name (Legal Business Name): JOSEPH MARIANO DEFRANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12409 LORAIN AVE
CLEVELAND OH
44111-3515
US

IV. Provider business mailing address

12409 LORAIN AVE
CLEVELAND OH
44111-3515
US

V. Phone/Fax

Practice location:
  • Phone: 216-252-6670
  • Fax:
Mailing address:
  • Phone: 216-252-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35.030285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: