Provider Demographics
NPI:1235343922
Name:EL BASH, MOHAMAD SALAH ELDEAN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:SALAH ELDEAN
Last Name:EL BASH
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 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8681
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1711 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-8772
Practice Address - Fax:740-354-2138
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2881207RI0011X
TXR0564207RI0011X
OH35.124245207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.124245OtherOH LICENSE
TXR0564OtherMD LICENSE
WV2177885OtherUHC
WV613154600OtherBLACK LUNG
KY7100048970Medicaid
OH2851589Medicaid
WV9468161OtherAETNA
WV3810012378Medicaid
WV4239721Medicare PIN