Provider Demographics
NPI:1548294127
Name:GARBADAWALA, MUSTAFA S (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:S
Last Name:GARBADAWALA
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 1:465 NORTH HOME RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2323
Mailing Address - Country:US
Mailing Address - Phone:419-747-1601
Mailing Address - Fax:419-747-1610
Practice Address - Street 1:465 NORTH HOME RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-2323
Practice Address - Country:US
Practice Address - Phone:419-747-1601
Practice Address - Fax:419-747-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131231Medicaid
OHGA0892072Medicare ID - Type Unspecified
OHH05107Medicare UPIN