1295957470 NPI number — SHERIF BOTROS MIKHAIL WASSEF MD MS FRCS

Table of content: SHERIF BOTROS MIKHAIL WASSEF MD MS FRCS (NPI 1295957470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295957470 NPI number — SHERIF BOTROS MIKHAIL WASSEF MD MS FRCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASSEF
Provider First Name:
SHERIF
Provider Middle Name:
BOTROS MIKHAIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD MS FRCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIKHAIL WASSEF
Provider Other First Name:
SHERIF
Provider Other Middle Name:
BOTROS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD MS FRCS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1295957470
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 LOWREY PL APT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06111-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-655-4037
Provider Business Mailing Address Fax Number:
860-666-4932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
241 LOWREY PL APT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06111-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-655-4037
Provider Business Practice Location Address Fax Number:
860-666-4932
Provider Enumeration Date:
05/03/2007

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: 2085R0202X , with the licence number:  MD069654L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: MD069654L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 102112804 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111236 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 212423 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1570603 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2026993 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7440881 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 919374 . This is a "CAREFIRST MD BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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