Healthcare Provider Details

I. General information

NPI: 1730310913
Provider Name (Legal Business Name): YUSEF OMARI MORANT-WADE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST MS 495
PHILADELPHIA PA
19102-1101
US

IV. Provider business mailing address

1802 PINE ST
PHILADELPHIA PA
19103-6641
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-8220
  • Fax: 215-762-1470
Mailing address:
  • Phone: 615-305-7589
  • Fax: 215-762-1470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT189751
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: