Basic Information
| Provider Information | |||||||||
| NPI: | 1609898121 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRAN | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ISABEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 METROHEALTH DRIVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44109 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 METROHEALTH DRIVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167782222 | ||||||||
| FaxNumber: | 2162866341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 11/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35-059893 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000183431 | 01 | OH | ANTHEM | OTHER | 363630 | 01 | OH | WELLCARE | OTHER | 5125806 | 01 | OH | AETNA | OTHER | 000000526048 | 01 | OH | ANTHEM | OTHER | 745915 | 01 | OH | BUCKEYE | OTHER | 000000221427 | 01 | OH | UNISON | OTHER | 0806935 | 01 | OH | BCMH | OTHER | 0806935 | 05 | OH | MEDICAID |