Provider Demographics
NPI:1073044590
Name:ABDELMALAK, MENA JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MENA
Middle Name:JOSEPH
Last Name:ABDELMALAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6249
Mailing Address - Country:US
Mailing Address - Phone:330-729-8972
Mailing Address - Fax:330-729-8973
Practice Address - Street 1:80 MARWOOD CIR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6249
Practice Address - Country:US
Practice Address - Phone:330-729-8972
Practice Address - Fax:330-729-8973
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.141258207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program