Healthcare Provider Details

I. General information

NPI: 1306548508
Provider Name (Legal Business Name): YASMEEN EZMIRLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

800 GARFIELD AVE RM G102
PARKERSBURG WV
26101-5376
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-7700
  • Fax: 740-374-7701
Mailing address:
  • Phone: 304-424-4575
  • Fax: 304-424-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.155285
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.155285
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: