Provider Demographics
NPI:1689855058
Name:ABDUL-AAL, AMINE R (MD)
Entity Type:Individual
Prefix:DR
First Name:AMINE
Middle Name:R
Last Name:ABDUL-AAL
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 1:200 GARFIELD DR NE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5557
Mailing Address - Country:US
Mailing Address - Phone:330-372-1828
Mailing Address - Fax:330-372-2659
Practice Address - Street 1:200 GARFIELD DR NE
Practice Address - Street 2:SUITE 1
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5557
Practice Address - Country:US
Practice Address - Phone:330-372-1828
Practice Address - Fax:330-372-2659
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-8800-A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155273Medicaid
OH0155273Medicaid