Provider Demographics
NPI:1164643136
Name:FAIRVIEW HOSPITAL
Entity Type:Organization
Organization Name:FAIRVIEW HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-476-7086
Mailing Address - Street 1:18200 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5605
Mailing Address - Country:US
Mailing Address - Phone:216-476-7086
Mailing Address - Fax:216-476-7604
Practice Address - Street 1:18200 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5605
Practice Address - Country:US
Practice Address - Phone:216-476-7086
Practice Address - Fax:216-476-7604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57011880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH57011880OtherTEMPORARY LICENSE #