Provider Demographics
NPI:1932121050
Name:NORTH SHORE GASTROENTEROLOGY, INC.
Entity type:Organization
Organization Name:NORTH SHORE GASTROENTEROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOUSAB
Authorized Official - Middle Name:I
Authorized Official - Last Name:TABBAA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-808-1212
Mailing Address - Street 1:850 COLUMBIA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-7215
Mailing Address - Country:US
Mailing Address - Phone:440-808-1212
Mailing Address - Fax:440-808-0321
Practice Address - Street 1:850 COLUMBIA RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-7215
Practice Address - Country:US
Practice Address - Phone:440-808-1212
Practice Address - Fax:440-808-0321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0727897Medicaid
OHCL6884OtherRAILROAD MEDICARE
OHCL6884OtherRAILROAD MEDICARE
OH9187631Medicare PIN
OH0727897Medicaid