Healthcare Provider Details

I. General information

NPI: 1639165145
Provider Name (Legal Business Name): NOSSON S GOLDFARB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 COCHRAN RD SUITE 404
SOLON OH
44139-3310
US

IV. Provider business mailing address

6001 COCHRAN RD SUITE 404
SOLON OH
44139-3310
US

V. Phone/Fax

Practice location:
  • Phone: 440-349-1700
  • Fax: 440-349-9935
Mailing address:
  • Phone: 440-349-1700
  • Fax: 440-349-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number67244
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number67244
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number67244
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: