Provider Demographics
NPI:1114223344
Name:DIRAJLAL-FARGO, SAHERA (DO)
Entity Type:Individual
Prefix:DR
First Name:SAHERA
Middle Name:
Last Name:DIRAJLAL-FARGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SAHERA
Other - Middle Name:
Other - Last Name:DIRAJLAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDO0343062080P0208X
OH34-0110922080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0091785Medicaid
OHH188170Medicare PIN