Provider Demographics
NPI:1235449687
Name:ISAM TABBAH MD INC
Entity Type:Organization
Organization Name:ISAM TABBAH MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-502-9284
Mailing Address - Street 1:5126 SILVER WOODS LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-7073
Mailing Address - Country:US
Mailing Address - Phone:740-502-9284
Mailing Address - Fax:
Practice Address - Street 1:5126 SILVER WOODS LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-7073
Practice Address - Country:US
Practice Address - Phone:740-502-9284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.038859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0304763Medicaid
OHA75566Medicare UPIN