Provider Demographics
NPI:1285623017
Name:TABAIE, MOHAMMAD B (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:B
Last Name:TABAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4503
Mailing Address - Country:US
Mailing Address - Phone:315-446-3904
Mailing Address - Fax:315-445-2936
Practice Address - Street 1:4850 BROAD RD
Practice Address - Street 2:SUITE 2G
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-5100
Practice Address - Country:US
Practice Address - Phone:315-492-5815
Practice Address - Fax:315-492-5831
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY135119208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D74973Medicare UPIN