Provider Demographics
NPI:1659397099
Name:SHABANEH, BAHAEDDIN A (MD)
Entity Type:Individual
Prefix:
First Name:BAHAEDDIN
Middle Name:A
Last Name:SHABANEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BAHAEDDIN
Other - Middle Name:
Other - Last Name:SHABANEH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-338-4004
Mailing Address - Fax:281-332-6524
Practice Address - Street 1:530 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4110
Practice Address - Country:US
Practice Address - Phone:281-338-4004
Practice Address - Fax:281-332-6524
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9296207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX296198901Medicaid
TX296198902Medicaid
TX296198901Medicaid