Provider Demographics
NPI:1720540982
Name:ABOU CHEHADE, JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:
Last Name:ABOU CHEHADE
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 1:141 GRANDE ISLE AVE SW UNIT 2123
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-3188
Mailing Address - Country:US
Mailing Address - Phone:507-202-9821
Mailing Address - Fax:
Practice Address - Street 1:234 E 149TH ST STE 8-20
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5504
Practice Address - Country:US
Practice Address - Phone:718-579-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program