Healthcare Provider Details

I. General information

NPI: 1538147921
Provider Name (Legal Business Name): HANEY WAHBA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SALTSBURG RD
CLARKSBURG PA
15725-7400
US

IV. Provider business mailing address

PO BOX 716 100 SHENANGO AVENUE
SHARON PA
16146-0716
US

V. Phone/Fax

Practice location:
  • Phone: 724-726-0300
  • Fax: 724-726-8812
Mailing address:
  • Phone: 724-726-0300
  • Fax: 724-726-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD041067E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: