Healthcare Provider Details

I. General information

NPI: 1447633730
Provider Name (Legal Business Name): ODAY AWAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FIFTH AVE
MCKEESPORT PA
15132
US

IV. Provider business mailing address

819 WORCESTER ST STE 3
SPRINGFIELD MA
01151-1056
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2782
  • Fax:
Mailing address:
  • Phone: 413-543-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT209843
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD475650
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number61128
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: