Provider Demographics
NPI:1336160498
Name:AZZOUZ, MAHER (MD)
Entity Type:Individual
Prefix:
First Name:MAHER
Middle Name:
Last Name:AZZOUZ
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 1:1622 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6613
Mailing Address - Country:US
Mailing Address - Phone:330-399-7215
Mailing Address - Fax:330-399-2411
Practice Address - Street 1:850 COLUMBIA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1493
Practice Address - Country:US
Practice Address - Phone:440-808-1212
Practice Address - Fax:440-808-0321
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057500L207RG0100X
OH35 091016207RI0008X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847932Medicaid
OH2847932Medicaid