Healthcare Provider Details

I. General information

NPI: 1174555296
Provider Name (Legal Business Name): ALY M ZEWAIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST FL 6
AKRON OH
44310-3110
US

IV. Provider business mailing address

444 N MAIN ST FL 6
AKRON OH
44310-3110
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-9915
  • Fax: 330-379-8191
Mailing address:
  • Phone: 330-379-9915
  • Fax: 330-889-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.200839
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number35088417
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number35088417
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35.088417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: