Provider Demographics
NPI:1205137858
Name:MUSTAFA, YASSIN M (MD,)
Entity type:Individual
Prefix:
First Name:YASSIN
Middle Name:M
Last Name:MUSTAFA
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 1:1989 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3823
Mailing Address - Country:US
Mailing Address - Phone:937-401-7575
Mailing Address - Fax:937-401-7570
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:STE 201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-401-7575
Practice Address - Fax:937-401-7570
Is Sole Proprietor?:No
Enumeration Date:2010-11-14
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126834207R00000X, 207RE0101X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165116Medicaid
OH000001007847OtherANTHEM
OH0165116Medicaid