Healthcare Provider Details

I. General information

NPI: 1982196168
Provider Name (Legal Business Name): EDWAR A YOUSSEF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8815 GERMANTOWN AVE
PHILADELPHIA PA
19118-2722
US

IV. Provider business mailing address

36 DALLENBACH LN
EAST BRUNSWICK NJ
08816-5684
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8145
  • Fax:
Mailing address:
  • Phone: 732-485-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMT215707
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD475242
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: