Healthcare Provider Details

I. General information

NPI: 1295924348
Provider Name (Legal Business Name): AYESHA WAHAB M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 PERKIOMEN AVE
READING PA
19606-2714
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-7570
  • Fax:
Mailing address:
  • Phone: 484-628-0799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD438247
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: