Healthcare Provider Details

I. General information

NPI: 1053760835
Provider Name (Legal Business Name): JAY GHADIALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2016
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 E HAVERFORD RD STE 200
BRYN MAWR PA
19010-3848
US

IV. Provider business mailing address

825 OLD LANCASTER RD STE 320
BRYN MAWR PA
19010-3235
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-4463
  • Fax: 610-527-2854
Mailing address:
  • Phone: 610-527-3800
  • Fax: 610-527-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT210707
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD467776
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMT210707
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: