Provider Demographics
NPI:1871664441
Name:ABBASS, ABDUL H (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:H
Last Name:ABBASS
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 1:6693 N CHESTNUT ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3922
Mailing Address - Country:US
Mailing Address - Phone:330-297-9080
Mailing Address - Fax:330-297-9077
Practice Address - Street 1:6693 N CHESTNUT ST
Practice Address - Street 2:SUITE 215
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3922
Practice Address - Country:US
Practice Address - Phone:330-297-9080
Practice Address - Fax:330-297-9077
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058622A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0731640Medicaid
OHD49490Medicare UPIN
OH0731640Medicaid