Provider Demographics
NPI:1487180592
Name:AL BANNA, MONA (MB BCH , MSC)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:AL BANNA
Suffix:
Gender:F
Credentials:MB BCH , MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-3220
Mailing Address - Country:US
Mailing Address - Phone:216-339-6844
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC FAIRVIEW HOSPITAL
Practice Address - Street 2:18101 LORAIN AVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111
Practice Address - Country:US
Practice Address - Phone:216-476-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-10
Last Update Date:2022-06-29
Deactivation Date:2017-12-13
Deactivation Code:
Reactivation Date:2018-08-01
Provider Licenses
StateLicense IDTaxonomies
FLME1567692084N0400X
PAMD4779142084N0400X
CT1.0690252084N0400X
390200000X
OH35.1453962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program