Provider Demographics
NPI:1144234121
Name:VICTOROFF, BRIAN N (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:N
Last Name:VICTOROFF
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 1:24701 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:216-383-6749
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:216-844-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-054273207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0858826Medicaid
OH000000203728OtherUNISON
000000503694OtherANTHEM
OHP00011025OtherRAILROAD MEDICARE
OH364097OtherWELLCARE
OH738112OtherBUCKEYE
OH0644818OtherAETNA
OHP00412645OtherRAILROAD MEDICARE
OH364097OtherWELLCARE
OHVI4104543Medicare PIN
VI4104544Medicare PIN