Provider Demographics
NPI:1134120504
Name:TABET, BECHARA GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:BECHARA
Middle Name:GEORGE
Last Name:TABET
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 1:1330 MERCY DR NW
Mailing Address - Street 2:STE 510
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2626
Mailing Address - Country:US
Mailing Address - Phone:330-456-6760
Mailing Address - Fax:330-456-8555
Practice Address - Street 1:1330 MERCY DR NW
Practice Address - Street 2:STE #510
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2626
Practice Address - Country:US
Practice Address - Phone:330-456-6760
Practice Address - Fax:330-456-8555
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068511208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152178Medicaid
0741757Medicare ID - Type Unspecified
4073331Medicare ID - Type Unspecified
OH0152178Medicaid
F59447Medicare UPIN
4073332Medicare ID - Type Unspecified
0741759Medicare ID - Type Unspecified