Provider Demographics
NPI:1558340430
Name:RAGHEB, ESSAM S (MD)
Entity Type:Individual
Prefix:
First Name:ESSAM
Middle Name:S
Last Name:RAGHEB
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 1:5901 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1171
Mailing Address - Country:US
Mailing Address - Phone:330-847-9911
Mailing Address - Fax:
Practice Address - Street 1:5901 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1171
Practice Address - Country:US
Practice Address - Phone:330-847-9911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9310401Medicare ID - Type Unspecified
OHA16362Medicare UPIN