Provider Demographics
NPI:1902854748
Name:MAIJUB, AMADO GABRIEL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:AMADO
Middle Name:GABRIEL
Last Name:MAIJUB
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:330 E 8TH ST STE 151
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3383
Practice Address - Country:US
Practice Address - Phone:740-374-4945
Practice Address - Fax:740-374-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0609207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV01054553000Medicaid
OH0251418Medicaid
OHP01266295OtherRAILROAD MEDICARE - MHCPI
OH0251418Medicaid
OHH242751Medicare PIN
B00274Medicare UPIN