Healthcare Provider Details

I. General information

NPI: 1992051635
Provider Name (Legal Business Name): MAGDA WADIE DAOUD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 05/11/2024
Certification Date: 05/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 RICHMOND AVE
STATEN ISLAND NY
10312-3848
US

IV. Provider business mailing address

3710 RICHMOND AVE
STATEN ISLAND NY
10312-3848
US

V. Phone/Fax

Practice location:
  • Phone: 718-450-0515
  • Fax: 718-450-0071
Mailing address:
  • Phone: 718-450-0515
  • Fax: 718-450-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number284507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: