Provider Demographics
NPI:1336182526
Name:JADALLAH, AHMAD KHALED (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:KHALED
Last Name:JADALLAH
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 1:121 NORTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1809
Mailing Address - Country:US
Mailing Address - Phone:330-633-1352
Mailing Address - Fax:330-633-6068
Practice Address - Street 1:121 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1809
Practice Address - Country:US
Practice Address - Phone:330-633-1352
Practice Address - Fax:330-633-6068
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069084207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2026551Medicare ID - Type Unspecified
OHJA0839631Medicare ID - Type UnspecifiedTALLMADGE
OHG62605Medicare UPIN
OHJA0839632Medicare ID - Type UnspecifiedGREEN
OHJA0839636Medicare ID - Type UnspecifiedMONTROSE