Healthcare Provider Details

I. General information

NPI: 1174903397
Provider Name (Legal Business Name): HUSSAM TALLAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 WILMINGTON RD
NEW CASTLE PA
16105-1100
US

IV. Provider business mailing address

3124 WILMINGTON RD
NEW CASTLE PA
16105-1100
US

V. Phone/Fax

Practice location:
  • Phone: 724-936-5333
  • Fax: 724-936-5339
Mailing address:
  • Phone: 724-936-5333
  • Fax: 724-936-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD494457
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number80.000072
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number263399
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number263399
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: