Provider Demographics
NPI:1871674432
Name:SALEEBY, HUSSAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSSAM
Middle Name:G
Last Name:SALEEBY
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 1:16954 CONNEAUT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3738
Mailing Address - Country:US
Mailing Address - Phone:814-360-6014
Mailing Address - Fax:
Practice Address - Street 1:16954 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3738
Practice Address - Country:US
Practice Address - Phone:814-360-6014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065701L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA187-167-4432OtherI DON'T KNOW
PANONEOtherI DON'T KNOW