Healthcare Provider Details

I. General information

NPI: 1578546792
Provider Name (Legal Business Name): SUAD A ISMAIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 E NORTH AVE SUITE 400
PITTSBURGH PA
15212-4740
US

IV. Provider business mailing address

490 E NORTH AVE SUITE 400
PITTSBURGH PA
15212-4740
US

V. Phone/Fax

Practice location:
  • Phone: 412-322-2622
  • Fax: 412-322-3093
Mailing address:
  • Phone: 412-322-2622
  • Fax: 412-322-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD068776-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD068776L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: