Provider Demographics
NPI: | 1063477529 |
---|---|
Name: | ABBOUD, SEMAAN M (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | SEMAAN |
Middle Name: | M |
Last Name: | ABBOUD |
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: | PO BOX 4110 |
Mailing Address - Street 2: | |
Mailing Address - City: | WOBURN |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 01888-4110 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-945-9730 |
Mailing Address - Fax: | 302-945-9732 |
Practice Address - Street 1: | 32711 LONG NECK RD |
Practice Address - Street 2: | |
Practice Address - City: | MILLSBORO |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19966-6678 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-945-9730 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-04-19 |
Last Update Date: | 2024-04-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
DE | C1-0003983 | 208600000X |
DE | C10003983 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty | |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DE | 0000486801 | Medicaid | |
DE | 0000486801 | Medicaid | |
DE | E50408 | Medicare UPIN |