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General NPI Number Information
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NPI Number | 1972829125
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Entity Type | Individual
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Provider Name | AVRAM DERROW M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 1620 BRIGHAM DR STE 130
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City | PERRYSBURG
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State | OH
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Zip | 43551-7124
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Country | US
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Telephone | 419-893-7211
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Fax | 419-893-8882
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE
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City | TOLEDO
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State | OH
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Zip | 43604-1516
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 35.098500
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35.098500
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License Number State | OH
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