Healthcare Provider Details

I. General information

NPI: 1184628950
Provider Name (Legal Business Name): MOURAD ABDELMESSIH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/14/2024
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 TAMARACK RD
NEWARK OH
43055-2303
US

IV. Provider business mailing address

1916 TAMARACK RD
NEWARK OH
43055-2303
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-6110
  • Fax: 740-522-0126
Mailing address:
  • Phone: 740-322-3794
  • Fax: 740-522-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number35070805
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35070805
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: