Healthcare Provider Details

I. General information

NPI: 1285666008
Provider Name (Legal Business Name): WHITE SQUARE VASCULAR SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 KING AVE SUITE 208
BALTIMORE MD
21237-4003
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-918-1525
  • Fax: 410-918-1526
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMAD ABU-GHAIDA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-918-1525