Basic Information
| Provider Information | |||||||||
| NPI: | 1932163748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHABAB | ||||||||
| FirstName: | WADIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 SUMMIT AVE | ||||||||
| Address2: | ATTN: PAMELA DICKINSON | ||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439522667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402837335 | ||||||||
| FaxNumber: | 7402837807 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | TORONTO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439641949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405376271 | ||||||||
| FaxNumber: | 7405371959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35070384 | OH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0255521 | 05 | OH | MEDICAID |