Provider Demographics
NPI:1487765467
Name:SADEGHIAN, ABBAS
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:
Last Name:SADEGHIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 HARRISON AVE NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2620
Mailing Address - Country:US
Mailing Address - Phone:330-994-0234
Mailing Address - Fax:330-994-0235
Practice Address - Street 1:1445 HARRISON AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-2620
Practice Address - Country:US
Practice Address - Phone:330-994-0234
Practice Address - Fax:330-994-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH40272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699436Medicaid
OH0699436Medicaid
OHCP07361Medicare PIN