Provider Demographics
NPI:1912520792
Name:KEBAB, MOHIEDDIN
Entity Type:Individual
Prefix:
First Name:MOHIEDDIN
Middle Name:
Last Name:KEBAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 DOCTORS LN
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8515
Mailing Address - Country:US
Mailing Address - Phone:814-226-3494
Mailing Address - Fax:814-226-3478
Practice Address - Street 1:24 DOCTORS LN STE 202
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8574
Practice Address - Country:US
Practice Address - Phone:814-226-2500
Practice Address - Fax:814-226-2501
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.148866207Q00000X
KY57502207Q00000X
PAMT220599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine