Basic Information
Provider Information
NPI: 1013273739
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SABEH
FirstName: MOHAMAD KHALED
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2315 MYRTLE ST STE 190
Address2:  
City: ERIE
State: PA
PostalCode: 165024604
CountryCode: US
TelephoneNumber: 8144537767
FaxNumber: 8144546667
Practice Location
Address1: 2315 MYRTLE ST STE 190
Address2:  
City: ERIE
State: PA
PostalCode: 165024604
CountryCode: US
TelephoneNumber: 8144537767
FaxNumber: 8144546667
Other Information
ProviderEnumerationDate: 04/06/2012
LastUpdateDate: 09/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000XMD471727PAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RC0001XMD471727PAY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

No ID Information.


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