Provider Demographics
NPI:1801861018
Name:TAHA, JAMAL M (MD)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:M
Last Name:TAHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3533 SOUTHERN BLVD
Mailing Address - Street 2:STE 3000
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1280
Mailing Address - Country:US
Mailing Address - Phone:937-299-8242
Mailing Address - Fax:937-299-8245
Practice Address - Street 1:3533 SOUTHERN BLVD
Practice Address - Street 2:STE 3000
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1280
Practice Address - Country:US
Practice Address - Phone:937-299-8242
Practice Address - Fax:937-299-8245
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2023-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2020022525207T00000X
KY32158207T00000X
SC35281207T00000X
ORMD213490207T00000X
OH35.070719207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256959Medicaid
OHP00002049Medicare PIN
OH0851897Medicare PIN
OHG65575Medicare UPIN