Provider Demographics
NPI:1619428778
Name:GASTROENTEROLOGY AND HEPATOLOGY OF NORTHWEST OHIO INC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY AND HEPATOLOGY OF NORTHWEST OHIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOUFAL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAJEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-228-3500
Mailing Address - Street 1:PO BOX 1448
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-1448
Mailing Address - Country:US
Mailing Address - Phone:419-228-3500
Mailing Address - Fax:
Practice Address - Street 1:915 MICHIGAN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-2401
Practice Address - Country:US
Practice Address - Phone:419-228-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35125504207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty