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Organization
TRUMBULL MAHONING MEDICAL GROUP, INC.
Active
Organization
TRUMBULL MAHONING MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOURAD ROSTOM M.D. (PRESIDENT/CEO)
(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
OH
Enumeration date
08/03/2006
Last updated
01/17/2014
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