MEDICARE: SAADEDDINE HIJAZI, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	MD020040E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	26257	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1013121672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAADEDDINE HIJAZI, MD

Provider Business Mailing Address
First Line	:	231 NORTHERN BLVD
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-585-8085
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 NORTHERN BLVD
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-585-8085
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SAADEDDINE HIJAZI
Credential	:	MD
Telephone Number	:	570-585-8085

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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