Healthcare Provider Details

I. General information

NPI: 1568982247
Provider Name (Legal Business Name): SOUMAYA BADER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SOUMAYA BADR

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 04/01/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 CEDAR RD STE B
CHESAPEAKE VA
23322-8376
US

IV. Provider business mailing address

2023 GREENFIELD LN
ALLEN TX
75013-2964
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0103301296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: