Provider Demographics
NPI:1386044485
Name:KABBAH, BALLAH A
Entity Type:Individual
Prefix:MR
First Name:BALLAH
Middle Name:A
Last Name:KABBAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6418 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-3110
Mailing Address - Country:US
Mailing Address - Phone:267-701-3341
Mailing Address - Fax:
Practice Address - Street 1:6418 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-3110
Practice Address - Country:US
Practice Address - Phone:267-701-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor