Provider Demographics
NPI:1053351494
Name:IMAM, MONA ABDELGALIL (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:ABDELGALIL
Last Name:IMAM
Suffix:
Gender:F
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 N 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2244
Practice Address - Country:US
Practice Address - Phone:740-373-0669
Practice Address - Fax:740-568-5228
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073285207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2253421Medicaid
WV0070455000Medicaid
OH2253421Medicaid
OHG87753Medicare UPIN
OHH186181Medicare PIN
OH2253421Medicaid
OH4058013Medicare PIN