Provider Demographics
NPI:1982658902
Name:ABBAS, SYED HAIDER (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:HAIDER
Last Name:ABBAS
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-4450
Mailing Address - Fax:859-258-4039
Practice Address - Street 1:1221 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2701
Practice Address - Country:US
Practice Address - Phone:859-258-4450
Practice Address - Fax:859-258-4039
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 20928207RR0500X
KYKY 37360207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841873000Medicaid
WV1841873000Medicaid
KY0169OtherMEDICARE GROUP NUMBER
KY37903705OtherMEDICAID LAB GROUP
KY0656606Medicare ID - Type Unspecified
KY0685905Medicare ID - Type Unspecified
H81790Medicare UPIN
KY0656506Medicare ID - Type Unspecified
WV1841873000Medicaid
KY0169OtherMEDICARE GROUP NUMBER