Basic Information
| Provider Information | |||||||||
| NPI: | 1619969235 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAOUDE | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ABOU JAOUDE | ||||||||
| OtherFirstName: | EDWARD | ||||||||
| OtherMiddleName: | S | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 58 | ||||||||
| Address2: | |||||||||
| City: | NASSAU | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199690058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026842020 | ||||||||
| FaxNumber: | 3026842021 | ||||||||
| Practice Location | |||||||||
| Address1: | 28322 LEWES GEORGETOWN HWY | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199683117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026842020 | ||||||||
| FaxNumber: | 3026842021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 05/29/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | C10006469 | DE | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1000015016 | 05 | DE | MEDICAID |