Provider Demographics
NPI:1639165145
Name:GOLDFARB, NOSSON S (MD)
Entity Type:Individual
Prefix:
First Name:NOSSON
Middle Name:S
Last Name:GOLDFARB
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 1:6001 COCHRAN RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3310
Mailing Address - Country:US
Mailing Address - Phone:440-349-1700
Mailing Address - Fax:440-349-9935
Practice Address - Street 1:6001 COCHRAN RD
Practice Address - Street 2:SUITE 404
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3310
Practice Address - Country:US
Practice Address - Phone:440-349-1700
Practice Address - Fax:440-349-9935
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67244207K00000X, 208VP0000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G18067Medicare UPIN
OH0165173Medicaid