1568404606 NPI number — DR. FRED ERIC SABOL D.O.

Table of content: DR. FRED ERIC SABOL D.O. (NPI 1568404606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568404606 NPI number — DR. FRED ERIC SABOL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SABOL
Provider First Name:
FRED
Provider Middle Name:
ERIC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SABOL
Provider Other First Name:
FRED
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1568404606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 SARVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEGLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
24731-9120
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-487-6599
Provider Business Mailing Address Fax Number:
304-487-5771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 STAFFORD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24740-2447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-487-4077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  966 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0051357000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".