Healthcare Provider Details

I. General information

NPI: 1861619975
Provider Name (Legal Business Name): WASIF A QURESHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BECKS WOODS DR SUITE 200
BEAR DE
19701-3851
US

IV. Provider business mailing address

1401 FOULK RD SUITE 101A
WILMINGTON DE
19803-2763
US

V. Phone/Fax

Practice location:
  • Phone: 302-834-7676
  • Fax: 302-834-9202
Mailing address:
  • Phone: 302-661-7676
  • Fax: 302-661-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC1-0008345
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: