Provider Demographics
NPI:1184628950
Name:ABDELMESSIH, MOURAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOURAD
Middle Name:
Last Name:ABDELMESSIH
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 1:1916 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-2303
Mailing Address - Country:US
Mailing Address - Phone:740-522-6110
Mailing Address - Fax:740-522-0126
Practice Address - Street 1:1916 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2303
Practice Address - Country:US
Practice Address - Phone:740-522-6110
Practice Address - Fax:740-522-0126
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070805174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342445Medicaid
OH9339121OtherMEDICARE GROUP
OH0501309OtherUNITED HEALTHCARE
OH00083088OtherMEDICARE RAILROAD
OHDA5551OtherMEDICARE RAILROAD GROUP
OH000000314456OtherANTHEM
OHG38492Medicare UPIN
OH0501309OtherUNITED HEALTHCARE