Provider Demographics
NPI:1083619530
Name:CHALABI, SAMIM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIM
Middle Name:
Last Name:CHALABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMIM
Other - Middle Name:
Other - Last Name:CELEBI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:37 PRATT AVE.
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848
Practice Address - Country:US
Practice Address - Phone:570-268-2423
Practice Address - Fax:570-268-2378
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071978L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154007Medicaid
PA1825714Medicaid
PA1825714Medicaid
PA1825714Medicaid