Provider Demographics
NPI:1891750287
Name:YAQUB, NADIA (MD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:YAQUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 MACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-5300
Mailing Address - Country:US
Mailing Address - Phone:513-603-8352
Mailing Address - Fax:513-603-8357
Practice Address - Street 1:2960 MACK RD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-5300
Practice Address - Country:US
Practice Address - Phone:513-603-8352
Practice Address - Fax:513-603-8357
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-091961207R00000X, 207RE0101X
WV20994207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200930530Medicaid
WV3810001998Medicaid
KY64117278Medicaid
OH2547926Medicaid
IN200930530Medicaid
OHH039780Medicare PIN
WVI26415Medicare UPIN
OH2547926Medicaid