Healthcare Provider Details

I. General information

NPI: 1770756710
Provider Name (Legal Business Name): ISMAIL RADY SAAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COTTMAN AVE
PHILADELPHIA PA
19111-2434
US

IV. Provider business mailing address

6123 BROOKVIEW PL
ELKINS PARK PA
19027-2812
US

V. Phone/Fax

Practice location:
  • Phone: 215-728-3564
  • Fax: 215-214-1734
Mailing address:
  • Phone: 856-366-6152
  • Fax: 215-214-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: