Provider Demographics
NPI:1306057294
Name:ABBAS, RAJA SOHAIL (MD)
Entity type:Individual
Prefix:
First Name:RAJA
Middle Name:SOHAIL
Last Name:ABBAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1824
Mailing Address - Country:US
Mailing Address - Phone:106-900-4234
Mailing Address - Fax:570-392-6143
Practice Address - Street 1:211 N 12TH ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1138
Practice Address - Country:US
Practice Address - Phone:610-377-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4339752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023379110001Medicaid
PA160965HSUOtherMEDICARE PTAN