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General NPI Number Information
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NPI Number | 1578757472
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Entity Type | Organization
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Legal Business Name | TRUMBULL MAHONING MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 09/04/2007
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 901 TRAILWOOD DR
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5008
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Country | US
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Telephone | 330-726-3000
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Fax | 330-726-2612
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Provider Business Mailing Address
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Address Line | 901 TRAILWOOD DR
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City | YOUNGSTOWN
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State | OH
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Zip | 44512-5008
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Country | US
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Telephone | 330-726-3000
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Fax | 330-726-2612
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. MOURAD ROSTOM
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Credential | M.D.
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Telephone | 330-372-8820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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