Provider Demographics
NPI:1184657157
Name:CHALABI, IZZAT (MD)
Entity type:Individual
Prefix:
First Name:IZZAT
Middle Name:
Last Name:CHALABI
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 1:8116 GOOD LUCK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3502
Mailing Address - Country:US
Mailing Address - Phone:240-241-7474
Mailing Address - Fax:301-731-5733
Practice Address - Street 1:8116 GOOD LUCK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3502
Practice Address - Country:US
Practice Address - Phone:240-241-7474
Practice Address - Fax:301-731-5733
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057375207U00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H47843Medicare UPIN