1821552670 NPI number — OSAMAH ZAYED BADWAN MD

Table of content: OSAMAH ZAYED BADWAN MD (NPI 1821552670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821552670 NPI number — OSAMAH ZAYED BADWAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADWAN
Provider First Name:
OSAMAH
Provider Middle Name:
ZAYED
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:
BADWAN MUSA
Provider Other First Name:
OSAMAH
Provider Other Middle Name:
ZAYED
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1821552670
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1512
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEIBA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00735-1512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-435-4746
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9500 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44195-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-444-2336
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2019

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: 207R00000X , with the licence number:  57.251185 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 35.149927 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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