Basic Information
| Provider Information | |||||||||
| NPI: | 1770756710 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAAD | ||||||||
| FirstName: | ISMAIL | ||||||||
| MiddleName: | RADY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6123 BROOKVIEW PL | ||||||||
| Address2: | |||||||||
| City: | ELKINS PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190272812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563666152 | ||||||||
| FaxNumber: | 2152141734 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 COTTMAN AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157283564 | ||||||||
| FaxNumber: | 2152141734 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.