Healthcare Provider Details

I. General information

NPI: 1154633477
Provider Name (Legal Business Name): HUSSAM KUDSI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD SUITE 235
PHILADELPHIA PA
19114-1445
US

IV. Provider business mailing address

434 GREENE LN
PHOENIXVILLE PA
19460-5613
US

V. Phone/Fax

Practice location:
  • Phone: 215-632-3630
  • Fax: 215-632-3544
Mailing address:
  • Phone: 817-341-2660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD430344
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: