1295957470 NPI number — SHERIF BOTROS MIKHAIL WASSEF MD MS FRCS

Table of content: (NPI 1831769355)

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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