Basic Information
Provider Information | |||||||||
NPI: | 1316945850 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | YOUSSEF B. CHEHADE, MD, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 340 MAIN ST | ||||||||
Address2: | STE. 670 | ||||||||
City: | WORCESTER | ||||||||
State: | MA | ||||||||
PostalCode: | 016081604 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5087543566 | ||||||||
FaxNumber: | 5084386364 | ||||||||
Practice Location | |||||||||
Address1: | 201 HIGHLAND ST | ||||||||
Address2: |   | ||||||||
City: | CLINTON | ||||||||
State: | MA | ||||||||
PostalCode: | 015101037 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9783680861 | ||||||||
FaxNumber: | 9783683939 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/08/2005 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHEHADE | ||||||||
AuthorizedOfficialFirstName: | YOUSSEF | ||||||||
AuthorizedOfficialMiddleName: | B | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9783680861 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X |   | MA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 9721223 | 05 | MA |   | MEDICAID |