Provider Demographics
NPI:1083682512
Name:SABBOUR, HANI (MD)
Entity Type:Individual
Prefix:DR
First Name:HANI
Middle Name:
Last Name:SABBOUR
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 1:25 JOHN CUMMINGS WAY
Mailing Address - Street 2:
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3244
Mailing Address - Country:US
Mailing Address - Phone:401-766-5959
Mailing Address - Fax:401-766-6758
Practice Address - Street 1:25 JOHN CUMMINGS WAY
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3224
Practice Address - Country:US
Practice Address - Phone:401-766-5959
Practice Address - Fax:401-766-6758
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI060070464OtherRR FEDERAL MEDICARE
RI2501577OtherUNITED HEALTH
RI7010074Medicaid
RI304656OtherPILGRIM/BLUE CHIP
RI409957OtherMA BLUE SHIELD
RI0000000224OtherBLUE CROSS BLUE SHIELD
RI0000000224OtherBLUE CROSS BLUE SHIELD
RI409957OtherMA BLUE SHIELD