Provider Demographics
NPI:1396140604
Name:JAJEH, NOUFAL
Entity type:Individual
Prefix:
First Name:NOUFAL
Middle Name:
Last Name:JAJEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 WAPAKONETA AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1460
Mailing Address - Country:US
Mailing Address - Phone:937-492-1575
Mailing Address - Fax:937-949-2707
Practice Address - Street 1:930 WAPAKONETA AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1460
Practice Address - Country:US
Practice Address - Phone:937-492-1575
Practice Address - Fax:937-949-2707
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62188207RG0100X
OH32.125504207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology