Provider Demographics
NPI:1447221346
Name:HALLABA, RADWAN SAADALLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:RADWAN
Middle Name:SAADALLAH
Last Name:HALLABA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7303
Mailing Address - Country:US
Mailing Address - Phone:843-552-3629
Mailing Address - Fax:843-576-5244
Practice Address - Street 1:8720 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7303
Practice Address - Country:US
Practice Address - Phone:843-552-3629
Practice Address - Fax:843-576-5244
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26704207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G36703Medicare UPIN