Provider Demographics
NPI:1770276230
Name:MUSALLAM, EYAD
Entity type:Individual
Prefix:
First Name:EYAD
Middle Name:
Last Name:MUSALLAM
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 1:3301 MERCY HEALTH BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1106
Mailing Address - Country:US
Mailing Address - Phone:513-215-9200
Mailing Address - Fax:513-215-9259
Practice Address - Street 1:3301 MERCY HEALTH BLVD STE 125
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1106
Practice Address - Country:US
Practice Address - Phone:513-215-9200
Practice Address - Fax:513-215-9259
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029730363L00000X, 363LA2200X
OHRN.419967390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program