Provider Demographics
NPI:1831197029
Name:CHEHADE, YOUSSEF B (MD)
Entity type:Individual
Prefix:DR
First Name:YOUSSEF
Middle Name:B
Last Name:CHEHADE
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 1:340 MAIN ST
Mailing Address - Street 2:STE. 670
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1604
Mailing Address - Country:US
Mailing Address - Phone:508-754-3566
Mailing Address - Fax:508-438-6364
Practice Address - Street 1:201 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-1037
Practice Address - Country:US
Practice Address - Phone:978-368-0861
Practice Address - Fax:978-368-3939
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA33848208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2052741Medicaid
MAE11029Medicare PIN
MA2052741Medicaid
MAAX0791Medicare PIN