Basic Information
| Provider Information | |||||||||
| NPI: | 1548647928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABBAGH | ||||||||
| FirstName: | OSAMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7501 GREENWAY CENTER DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENBELT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207703514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592633900 | ||||||||
| FaxNumber: | 8592633757 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N EAGLE CREEK DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592633900 | ||||||||
| FaxNumber: | 8592633757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 07/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | MTL003943 | DC | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 0101272590 | VA | Y | 207W00000X | 52826 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1548647928 | 05 | WV | MEDICAID | 7100609590 | 05 | KY | MEDICAID | 300026869 | 05 | IN | MEDICAID | 0353512 | 05 | OH | MEDICAID |