Provider Demographics
NPI:1427055649
Name:NAWAB, SABAHAT (MD)
Entity type:Individual
Prefix:
First Name:SABAHAT
Middle Name:
Last Name:NAWAB
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 1:1119 BISHOP WALSH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1903
Mailing Address - Country:US
Mailing Address - Phone:301-605-4239
Mailing Address - Fax:
Practice Address - Street 1:1119 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1903
Practice Address - Country:US
Practice Address - Phone:301-605-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058655207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD440082801Medicaid
MD433LMedicare ID - Type Unspecified
MD440082801Medicaid