Provider Demographics
NPI:1801866272
Name:WAHHAB, ABDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:
Last Name:WAHHAB
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:17970-0157
Mailing Address - Country:US
Mailing Address - Phone:570-429-1000
Mailing Address - Fax:570-429-1532
Practice Address - Street 1:278 INDUSTRIAL PARK ROAD
Practice Address - Street 2:
Practice Address - City:ST. CLAIR
Practice Address - State:PA
Practice Address - Zip Code:17970-0157
Practice Address - Country:US
Practice Address - Phone:570-429-1000
Practice Address - Fax:570-429-1532
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014827E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006110700002Medicaid
PA113904EQ0Medicare ID - Type Unspecified
PAB36944Medicare UPIN