Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 35069084 | OH |
NPI | 1336182526 |
---|---|
Provider Name | Dr. Ahmad Khaled Jadallah |
First Address | Tallmadge, OH 44278-1809 |
Second Address | Tallmadge, OH 44278-1809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 29/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G62605 | (02) | OH |