Dallal, Mohammed Mazen
Dallal, Mohammed Mazen is an individual health care provider with primary practice located at 1520 S Main St # 2, Dayton OH 45409-2698. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Sleep Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Dallal, Mohammed Mazen can be contacted via phone (937) 461-5815.Contact Information
Primary practice address
1520 S Main St # 2
Dayton OH 45409-2698
Phone: (937) 461-5815
Fax: (937) 461-2896
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 35067761 | Ohio |
| Allopathic & Osteopathic Physicians / Sleep Medicine | 207RS0012X | 35067761 | Ohio |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | 35067761 | Ohio |
Profile Details
| NPI number | 1366434995 |
|---|---|
| LBN Legal business name | Dallal, Mohammed Mazen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 19th, 2005 |
| Last updated | Dec 14th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1366434995 | NPPES |
| Ohio | Other | 000000012616 | ANTHEM BCBS |
| Ohio | MEDICAID | 0178196 | ANTHEM BCBS |
| Ohio | Other | 4820106 | ANTHEM BCBS |
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