Provider Demographics
NPI:1952487712
Name:ABOU HAIDAR, SAID N (MD)
Entity Type:Individual
Prefix:DR
First Name:SAID
Middle Name:N
Last Name:ABOU HAIDAR
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 1:223 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1004
Mailing Address - Country:US
Mailing Address - Phone:440-930-2002
Mailing Address - Fax:440-930-2085
Practice Address - Street 1:223 MILLER RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1004
Practice Address - Country:US
Practice Address - Phone:440-930-2002
Practice Address - Fax:440-930-2085
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350574642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0927153Medicaid
OHF18504Medicare UPIN
OH0927153Medicaid