Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 35073285 | OH |
NPI | 1053351494 |
---|---|
Provider Name | Mona Abdelgalil Imam |
First Address | Marietta, OH 45750-0449 |
Second Address | Marietta, OH 45750-3382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0070455000 | (05) | WV |
2253421 | (05) | OH |
G87753 | (02) | OH |