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General NPI Number Information
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NPI Number | 1174903397
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Entity Type | Individual
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Provider Name | HUSSAM TALLAB M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 7620 SOUTHERN BLVD STE 1
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5667
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Country | US
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Telephone | 330-629-2144
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Fax | 330-629-2140
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Provider Business Mailing Address
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Address Line | 100 DEBARTOLO PL STE 200
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-6095
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Country | US
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Telephone | 330-729-8146
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Fax | 330-965-5229
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 263399
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 263399
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 80.000072
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License Number State | OH
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