Provider Demographics
NPI:1316977663
Name:TAHIR-FADLALLAH, ADNAN H (MD)
Entity type:Individual
Prefix:DR
First Name:ADNAN
Middle Name:H
Last Name:TAHIR-FADLALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2322 E 22ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3176
Mailing Address - Country:US
Mailing Address - Phone:216-363-2556
Mailing Address - Fax:
Practice Address - Street 1:4758 RIDGE RD
Practice Address - Street 2:#161
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-3327
Practice Address - Country:US
Practice Address - Phone:440-236-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057864-T207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0884619Medicaid
OH0884619Medicaid
OH0675072Medicare ID - Type Unspecified