Provider Demographics
NPI:1932163748
Name:SHABAB, WADIE (MD)
Entity Type:Individual
Prefix:
First Name:WADIE
Middle Name:
Last Name:SHABAB
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 1:380 SUMMIT AVE
Mailing Address - Street 2:ATTN: PAMELA DICKINSON
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-7335
Mailing Address - Fax:740-283-7807
Practice Address - Street 1:1800 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:TORONTO
Practice Address - State:OH
Practice Address - Zip Code:43964-1949
Practice Address - Country:US
Practice Address - Phone:740-537-6271
Practice Address - Fax:740-537-1959
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070384208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0255521Medicaid
G33444Medicare UPIN
0807322Medicare ID - Type Unspecified