Provider Demographics
NPI:1023042850
Name:YOUSSEF, SAMEH IBRAHIM (MD)
Entity type:Individual
Prefix:
First Name:SAMEH
Middle Name:IBRAHIM
Last Name:YOUSSEF
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 1:2600 STATE ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9393
Mailing Address - Country:US
Mailing Address - Phone:330-372-8800
Mailing Address - Fax:330-372-8999
Practice Address - Street 1:2600 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:330-372-8800
Practice Address - Fax:330-372-8999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH403120OtherUNITED HEALTHCARE
OH114508OtherHEALTH ASSURANCE
OH0459972Medicaid
OH341341025029OtherCARESOURCE
OH000000243193OtherANTHEM BC/BS
OHJ70211OtherSUMMACARE
OHQ005835AOtherHOMETOWN
OH$$$$$$$$$OtherTRICARE/HEALTHNET
OH$$$$$$$$$012OtherMEDICAL MUTUAL OF OHIO
OH$$$$$$$$$-00OtherWORKERS COMP
OH000000243193OtherANTHEM BC/BS
OH341341025029OtherCARESOURCE
OH$$$$$$$$$-00OtherWORKERS COMP
OH403120OtherUNITED HEALTHCARE