Provider Demographics
NPI:1538147921
Name:WAHBA, HANEY (MD)
Entity type:Individual
Prefix:
First Name:HANEY
Middle Name:
Last Name:WAHBA
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:PO BOX 716
Mailing Address - Street 2:100 SHENANGO AVENUE
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-0716
Mailing Address - Country:US
Mailing Address - Phone:724-726-0300
Mailing Address - Fax:724-726-8812
Practice Address - Street 1:29 SALTSBURG RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:PA
Practice Address - Zip Code:15725-7400
Practice Address - Country:US
Practice Address - Phone:724-726-0300
Practice Address - Fax:724-726-8812
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041067E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018680050003Medicaid
PA0018680050003Medicaid