Provider Demographics
NPI:1629566054
Name:KABASHNEH, SOHAIP MOHAMMAD SHAFEEQ (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIP
Middle Name:MOHAMMAD SHAFEEQ
Last Name:KABASHNEH
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 1:55 LAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01655-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-334-1131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2024-02-12
Deactivation Date:2018-12-13
Deactivation Code:
Reactivation Date:2018-12-31
Provider Licenses
StateLicense IDTaxonomies
390200000X
UT13658669-1205207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology