Provider Demographics
NPI:1194795740
Name:WAHHAB, SAMINA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:
Last Name:WAHHAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 SOUTH CEDAR CREST BLVD SUITE 1100
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-770-7676
Mailing Address - Fax:610-770-1412
Practice Address - Street 1:1255 S CEDAR CREST BLVD SUITE 1100
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-770-7676
Practice Address - Fax:610-770-1412
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066945L208200000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1862852Medicaid
PA148823Medicare PIN
PA1862852Medicaid