Provider Demographics
NPI:1275772931
Name:BOU MATAR, RAED NABIL (MD)
Entity Type:Individual
Prefix:
First Name:RAED
Middle Name:NABIL
Last Name:BOU MATAR
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 1:32635 STONY BROOK LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1938
Mailing Address - Country:US
Mailing Address - Phone:216-318-7099
Mailing Address - Fax:216-448-6015
Practice Address - Street 1:8950 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-444-6123
Practice Address - Fax:216-448-6015
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003533390200000X
OH35.0969502080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068010Medicaid