Provider Demographics
NPI:1326381682
Name:DECARO, GARREN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:GARREN
Middle Name:JAMES
Last Name:DECARO
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 1:16600 W SPRAGUE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6318
Mailing Address - Country:US
Mailing Address - Phone:440-826-0500
Mailing Address - Fax:440-826-0501
Practice Address - Street 1:16600 W SPRAGUE RD
Practice Address - Street 2:STE 120
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6318
Practice Address - Country:US
Practice Address - Phone:440-826-0500
Practice Address - Fax:440-826-0501
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.127939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program