Provider Demographics
NPI:1457343584
Name:MAROCCO, AVI S (MD)
Entity type:Individual
Prefix:MR
First Name:AVI
Middle Name:S
Last Name:MAROCCO
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 1:12000 MCCRACKEN RD.
Mailing Address - Street 2:SUITE 550
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-587-4600
Mailing Address - Fax:216-663-0666
Practice Address - Street 1:12000 MCCRACKEN ROAD
Practice Address - Street 2:SUITE 550
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-587-4600
Practice Address - Fax:216-663-0666
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077929207R00000X
OH35077929M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2326987Medicaid
OHMA4061493Medicare PIN
OH2326987Medicaid