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General NPI Number Information
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NPI Number | 1154349074
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Entity Type | Individual
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Provider Name | JONATHAN M FANAROFF MD
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-7700
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Fax | 216-286-6341
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Provider Business Mailing Address
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Address Line | 24701 EUCLID AVE 3RD FLOOR
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City | EUCLID
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State | OH
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Zip | 44117-1714
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 35-081809
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35-081809
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 35-081809
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License Number State | OH
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