1790163434 NPI number — DR. HENRI TOUFIC TRABOULSI M.D.

Table of content: DR. HENRI TOUFIC TRABOULSI M.D. (NPI 1790163434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790163434 NPI number — DR. HENRI TOUFIC TRABOULSI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRABOULSI
Provider First Name:
HENRI
Provider Middle Name:
TOUFIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790163434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/23/2015
NPI Reactivation Date:
02/25/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
331 JUSTISON ST
Provider Second Line Business Mailing Address:
APT 403
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19801-5181
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-467-3631
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 JUSTISON ST
Provider Second Line Business Practice Location Address:
APT 403
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19801-5181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-467-3631
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  45841 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com