Provider Demographics
NPI:1740485168
Name:JABBOUR, NICOLA (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:
Last Name:JABBOUR
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:
Practice Address - Street 1:3470 BLAZER PKWY STE 350
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2713
Practice Address - Country:US
Practice Address - Phone:859-629-7110
Practice Address - Fax:859-543-1989
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43211207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100126710Medicaid
000000864630OtherANTHEM BLUE CROSS AND BLUE SHIELD
CS1424500286OtherHUMANA CARESOURCE
000000864630OtherANTHEM BLUE CROSS AND BLUE SHIELD
P400022927Medicare PIN