Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 269018 | NY |
N | 208000000X | Pediatrician | 35-131055 | OH |
N | 2080P0210X | Pediatric Nephrologist | 269018 | NY |
Y | 2080P0210X | Pediatric Nephrologist | 35-131055 | OH |
NPI | 1396935508 |
---|---|
Provider Name | Mahmoud Kallash |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2007 |
Last Update Date | 11/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0218203 | (05) | OH |
03573264 | (05) | NY |
H589820 | MEDICARE-CGS (01) | OH |