MEDICARE: DR. ABDALLAH KABBARA MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	35.081154	OH
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	35081154	OH
3	208VP0000X	Pain Medicine Physician	35.081154	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00603623	OTHER	OH	MEDICARE RAILROAD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	0583328	OTHER	OH	BCMH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1275526428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDALLAH KABBARA MD

Provider Business Mailing Address
First Line	:	PO BOX 8792
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-8792
Country	:	US
Telephone Number	:	440-827-5058
Fax Number	:	440-827-5478

Provider Business Practice Location Address
First Line	:	29000 CENTER RIDGE RD
Second Line	:	1ST FL - PAIN CENTER
City	:	WESTLAKE
State	:	OH
Zip	:	44145-5293
Country	:	US
Telephone Number	:	440-827-5058
Fax Number	:	440-827-5478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	12/11/2020

29000 CENTER RIDGE RD , ST JOHN MEDICAL CENTER
WESTLAKE, OH
44145-5293

Practice Phone: 440-835-8000
Practice Fax:

29000 CENTER RIDGE RD
WESTLAKE, OH
44145-5293