Healthcare Provider Details

I. General information

NPI: 1790747996
Provider Name (Legal Business Name): AHMED ABDEL-GAWAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BYRN ST SUITE A
CAMBRIDGE MD
21613-2076
US

IV. Provider business mailing address

400 BYRN ST SUITE A
CAMBRIDGE MD
21613-2076
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-6161
  • Fax: 410-228-8396
Mailing address:
  • Phone: 410-228-6161
  • Fax: 410-228-8396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD50279
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: