Healthcare Provider Details

I. General information

NPI: 1548499767
Provider Name (Legal Business Name): AMIR A ABDEL-WAHAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 7TH AVE STE 3170
WEST READING PA
19611-1410
US

IV. Provider business mailing address

50 COMMERCE DR
WYOMISSING PA
19610-3335
US

V. Phone/Fax

Practice location:
  • Phone: 610-898-9380
  • Fax: 610-478-1170
Mailing address:
  • Phone: 610-372-8044
  • Fax: 484-334-7026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD445380
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: