Provider Demographics
NPI:1861189250
Name:OMAR KHALED ALZUBI, YAZAN (MD)
Entity type:Individual
Prefix:
First Name:YAZAN
Middle Name:
Last Name:OMAR KHALED ALZUBI
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 1:1001 COVINGTON ST.
Mailing Address - Street 2:ST. ELIZABETH YOUNGSTOWN HOSPITAL, INTERNAL MEDICINE
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 COVINGTON ST.
Practice Address - Street 2:ST. ELIZABETH YOUNGSTOWN HOSPITAL, INTERNAL MEDICINE
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510
Practice Address - Country:US
Practice Address - Phone:330-480-2616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57255062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program