Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 57.030408 | OH |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | C7-0005739 | DE |
NPI | 1346609740 |
---|---|
Provider Name | Oussama Abousamra |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205-2664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2016 |
Last Update Date | 03/08/2017 |