Healthcare Provider Details

I. General information

NPI: 1194989574
Provider Name (Legal Business Name): MAHONING VALLEY HIGH RISK OBSTETRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 SOUTH AVE SUITE 2
BOARDMAN OH
44512-6434
US

IV. Provider business mailing address

8170 SOUTH AVE SUITE 2
BOARDMAN OH
44512-6434
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-6380
  • Fax: 330-965-6390
Mailing address:
  • Phone: 330-965-6380
  • Fax: 330-965-6390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number35068255
License Number StateOH

VIII. Authorized Official

Name: DR. SAYED A EL-AZEEM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-965-6380