Provider Demographics
NPI:1619236353
Name:AMIREH, AHMAD MUSTAFA (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:MUSTAFA
Last Name:AMIREH
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 1:3550 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-1908
Mailing Address - Country:US
Mailing Address - Phone:330-941-9768
Mailing Address - Fax:
Practice Address - Street 1:5700 DARROW RD
Practice Address - Street 2:SUITE 106
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5026
Practice Address - Country:US
Practice Address - Phone:330-656-5911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.124363207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program