Provider Demographics
NPI:1275526428
Name:KABBARA, ABDALLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDALLAH
Middle Name:
Last Name:KABBARA
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 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-827-5058
Mailing Address - Fax:440-827-5478
Practice Address - Street 1:29000 CENTER RIDGE RD
Practice Address - Street 2:1ST FL - PAIN CENTER
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5293
Practice Address - Country:US
Practice Address - Phone:440-827-5058
Practice Address - Fax:440-827-5478
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.081154207L00000X, 208VP0000X
OH35081154207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00603623OtherMEDICARE RAILROAD
OH0583328OtherBCMH
OH2465961Medicaid
OHKA4155883Medicare PIN