Healthcare Provider Details

I. General information

NPI: 1083682512
Provider Name (Legal Business Name): HANI SABBOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JOHN CUMMINGS WAY
WOONSOCKET RI
02895-3224
US

IV. Provider business mailing address

25 JOHN CUMMINGS WAY
WOONSOCKET RI
02895-3244
US

V. Phone/Fax

Practice location:
  • Phone: 401-766-5959
  • Fax: 401-766-6758
Mailing address:
  • Phone: 401-766-5959
  • Fax: 401-766-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD11030
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: