Provider Demographics
NPI:1164884102
Name:TABBAA, ADAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:S
Last Name:TABBAA
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 1:850 COLUMBIA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7215
Mailing Address - Country:US
Mailing Address - Phone:440-808-0522
Mailing Address - Fax:440-808-2060
Practice Address - Street 1:850 COLUMBIA RD #200
Practice Address - Street 2:STE #200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7215
Practice Address - Country:US
Practice Address - Phone:440-808-0522
Practice Address - Fax:440-808-2060
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.139711207RG0100X, 207RG0100X
OH261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ00545243OtherMEDICARE RAILROAD
OH0019780Medicaid