Provider Demographics
NPI:1972008167
Name:JALLOH, MOHAMED ISSAH (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:ISSAH
Last Name:JALLOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 CAMPUS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2308
Mailing Address - Country:US
Mailing Address - Phone:502-928-0060
Mailing Address - Fax:502-928-0069
Practice Address - Street 1:2800 BRECKENRIDGE LN STE 410
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1780
Practice Address - Country:US
Practice Address - Phone:502-928-0060
Practice Address - Fax:502-928-0069
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
KYTP442207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program