Healthcare Provider Details

I. General information

NPI: 1457905275
Provider Name (Legal Business Name): MOHSEN ABDELSATTAR ABDELAZI FARGHALY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLEVELAND CLINIC CHILDREN'S HOSPITAL NICU
CLEVELAND OH
44195
US

IV. Provider business mailing address

CLEVELAND CLINIC CHILDREN'S HOSPITAL NEONATOLOGY DIVISION
CLEVELAND OH
44195-1900
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2568
  • Fax:
Mailing address:
  • Phone: 216-444-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.142800
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35.142800
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: