Provider Demographics
NPI:1417113085
Name:KHABBAZ, EYAD (MD)
Entity Type:Individual
Prefix:DR
First Name:EYAD
Middle Name:
Last Name:KHABBAZ
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 1:81 HILLCREST DR
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-4910
Mailing Address - Fax:814-938-5461
Practice Address - Street 1:81 HILLCREST DR
Practice Address - Street 2:BP-4109
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-4910
Practice Address - Fax:814-938-5461
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
GA004294207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA207Y00000XMedicaid
311170846OtherUNIVERSITY EAR NOSE AND THROAT SPECIALISTS