Provider Demographics
NPI:1790131738
Name:MAGZOUB, GREEBALLA
Entity Type:Individual
Prefix:DR
First Name:GREEBALLA
Middle Name:
Last Name:MAGZOUB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 THOMAS LN STE 3A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1419
Mailing Address - Country:US
Mailing Address - Phone:614-566-2500
Mailing Address - Fax:
Practice Address - Street 1:500 THOMAS LN STE 3A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1419
Practice Address - Country:US
Practice Address - Phone:614-566-2500
Practice Address - Fax:614-533-0335
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.144113207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program