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General NPI Number Information
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NPI Number | 1417113085
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Entity Type | Individual
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Provider Name | EYAD KHABBAZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 81 HILLCREST DR BP-4109
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City | PUNXSUTAWNEY
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State | PA
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Zip | 15767-2605
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Country | US
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Telephone | 814-938-4910
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Fax | 814-938-5461
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Provider Business Mailing Address
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Address Line | 81 HILLCREST DR SUITE 2600
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City | PUNXSUTAWNEY
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State | PA
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Zip | 15767-2605
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Country | US
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Telephone | 814-938-4910
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Fax | 814-938-5461
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 004294
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License Number State | GA
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