Provider Demographics
NPI:1184642050
Name:TABBAA, MOUSAB I (MD)
Entity Type:Individual
Prefix:
First Name:MOUSAB
Middle Name:I
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:440-808-1212
Mailing Address - Fax:440-808-0321
Practice Address - Street 1:850 COLUMBIA RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7215
Practice Address - Country:US
Practice Address - Phone:440-808-1212
Practice Address - Fax:440-808-2060
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053272207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110039356OtherRAILROAD MEDICARE
OH0727637Medicaid
OHE07221Medicare UPIN
OHTA0627472Medicare ID - Type Unspecified