Healthcare Provider Details

I. General information

NPI: 1205260890
Provider Name (Legal Business Name): COLUMBIANA GASTROENTEROLOGY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 E STATE ROUTE 14
COLUMBIANA OH
44408-8494
US

IV. Provider business mailing address

1622 E MARKET ST
WARREN OH
44483-6613
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-7215
  • Fax: 330-399-2411
Mailing address:
  • Phone: 330-399-7215
  • Fax: 330-399-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35058015
License Number StateOH

VIII. Authorized Official

Name: DR. ADEL YOUSSEF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-399-7215