Healthcare Provider Details

I. General information

NPI: 1568834364
Provider Name (Legal Business Name): ZAID ALSHAALAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 WALNUT ST STE 801
PHILADELPHIA PA
19107-5001
US

IV. Provider business mailing address

7924 SPRUCE LAKE LN APT 201
MEMPHIS TN
38119-4528
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8768
  • Fax:
Mailing address:
  • Phone: 901-493-2155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number390200000X
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: