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Organization
TRUMBULL MAHONING MEDICAL GROUP, INC.
Active
Organization
TRUMBULL MAHONING MEDICAL GROUP, INC.
Active
Parent organization
TRUMBULL MAHONING MEDICAL GROUP, INC.
Other names
TMMG
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRUMBULL MAHONING MEDICAL GROUP, INC.
Authorized official
DR. MOURAD ROSTOM M.D. (PARTNER/EXECUTIVE)
(330) 372-8820
Entity
Organization
Contact information
Practice address
2600 ELM RD NE, CORTLAND, OH 44410-9393
(330) 372-8800
(330) 372-8999
Mailing address
2600 ELM RD NE, CORTLAND, OH 44410-9393
(330) 372-8800
(330) 372-8999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000243183
ANTHEM BC/BS OHIO
OH
05
—
0468677
—
OH
01
—
1426141
HIGHMARK BC/BS PA
OH
Enumeration date
09/04/2007
Last updated
01/17/2014
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