Provider Demographics
NPI:1639116882
Name:DALIEH, SADI D (MD)
Entity Type:Individual
Prefix:
First Name:SADI
Middle Name:D
Last Name:DALIEH
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 1:1322 HAYMARKET WAY
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4604
Mailing Address - Country:US
Mailing Address - Phone:330-603-0700
Mailing Address - Fax:
Practice Address - Street 1:1322 HAYMARKET WAY
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4604
Practice Address - Country:US
Practice Address - Phone:330-603-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072579D207P00000X
CAC130369207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110185810OtherMEDICARE RR-GA
OH2022804Medicaid
OH942460636328OtherCARESOURCE
OH110185810OtherMEDICARE RR-GA
OH2022804Medicaid