1245851740 NPI number — AHMED WAGIH MOHAMED SABER MOAWAD MD

Table of content: AHMED WAGIH MOHAMED SABER MOAWAD MD (NPI 1245851740)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245851740 NPI number — AHMED WAGIH MOHAMED SABER MOAWAD MD

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
MOAWAD

Provider First Name:
AHMED

Provider Middle Name:
WAGIH MOHAMED SABER

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:
MD

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
MOAWAD

Provider Other First Name:
AHMED

Provider Other Middle Name:
W

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
MD

Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245851740

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
05/07/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7900 CAMBRIDGE ST APT 23-2G

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
HOUSTON

Provider Business Mailing Address State Name:
TX

Provider Business Mailing Address Postal Code:
77054-5577

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
832-613-2988

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 LANSDOWNE AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
DARBY

Provider Business Practice Location Address State Name:
PA

Provider Business Practice Location Address Postal Code:
19023-1200

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
610-237-4000

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
05/06/2020

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: 390200000X , with the licence number: MT220204 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .