Basic Information
Provider Information | |||||||||
NPI: | 1124381256 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FARRO | ||||||||
FirstName: | OKSANA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | AA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KOZLOVSKAYA | ||||||||
OtherFirstName: | OKSANA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | AA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 18697 BAGLEY RD | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG HEIGHTS | ||||||||
State: | OH | ||||||||
PostalCode: | 441303417 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4408166246 | ||||||||
FaxNumber: | 4408216263 | ||||||||
Practice Location | |||||||||
Address1: | 18697 BAGLEY RD | ||||||||
Address2: |   | ||||||||
City: | MIDDLEBURG HEIGHTS | ||||||||
State: | OH | ||||||||
PostalCode: | 441303417 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4408166246 | ||||||||
FaxNumber: | 4408166263 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/22/2012 | ||||||||
LastUpdateDate: | 03/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/10/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367H00000X | 67.000203 | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Anesthesiologist Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 0070897 | 05 | OH |   | MEDICAID |