Healthcare Provider Details

I. General information

NPI: 1720481567
Provider Name (Legal Business Name): MOHAMMED ISMAIL ALSOMALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5905
  • Fax: 614-293-4715
Mailing address:
  • Phone: 614-293-3055
  • Fax: 614-293-7273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number35133172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: