Healthcare Provider Details

I. General information

NPI: 1649273764
Provider Name (Legal Business Name): ANDREAS UJDUD WALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 POPLAR CHURCH RD SUITE 400
CAMP HILL PA
17011-2203
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 717-724-6450
  • Fax: 717-724-6451
Mailing address:
  • Phone: 717-724-6450
  • Fax: 717-724-6451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD068378L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD068378L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: