Healthcare Provider Details

I. General information

NPI: 1962432906
Provider Name (Legal Business Name): WAHOUB M HOUT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

IV. Provider business mailing address

1001 BELMONT AVE
YOUNGSTOWN OH
44504-1003
US

V. Phone/Fax

Practice location:
  • Phone: 330-747-6446
  • Fax: 330-747-6843
Mailing address:
  • Phone: 330-747-6446
  • Fax: 330-747-6843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35057030
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35.057030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: