Healthcare Provider Details

I. General information

NPI: 1902286560
Provider Name (Legal Business Name): ANDREW HANNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

8055 MAYFIELD RD STE 105
CHESTERLAND OH
44026-2447
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-5785
  • Fax: 216-844-2888
Mailing address:
  • Phone: 216-844-5785
  • Fax: 216-844-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number35.154363
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: