Provider Demographics
NPI:1245814037
Name:ABOU ISSA, ABDELFATAH SHABAN (MD)
Entity type:Individual
Prefix:
First Name:ABDELFATAH
Middle Name:SHABAN
Last Name:ABOU ISSA
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 1:3594 ARMADA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-5792
Mailing Address - Country:US
Mailing Address - Phone:360-292-0229
Mailing Address - Fax:
Practice Address - Street 1:GEISINGER WYOMING VALLEY 1000 EAST MOUNTAIN BLVD WILKES
Practice Address - Street 2:
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711
Practice Address - Country:US
Practice Address - Phone:570-808-3596
Practice Address - Fax:570-808-5967
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.151776207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program