1982457321 NPI number — WHITE SQUARE VASCULAR SURGERY PA

Table of content: SETH DAVID IZENBERG MD (NPI 1558331363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982457321 NPI number — WHITE SQUARE VASCULAR SURGERY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITE SQUARE VASCULAR SURGERY PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982457321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5233 KING AVE STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSEDALE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21237-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
141-091-8152
Provider Business Mailing Address Fax Number:
410-918-1525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8817 BELAIR RD STE 109
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOTTINGHAM
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21236-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-870-3325
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2024

Additional Information

Authorized Official

Authorized Official Last Name:
ABU-GHAIDA
Authorized Official First Name:
NBIAL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
410-918-1525

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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