Healthcare Provider Details

I. General information

NPI: 1942685375
Provider Name (Legal Business Name): YAQEEN QUDAH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 S MAIN ST
WOODSTOCK VA
22664-1154
US

IV. Provider business mailing address

125 PATTERSON STREET CLINICAL ACADEMIC BUILDING CAB 7300
NEW BRUNSWICK NJ
08901
US

V. Phone/Fax

Practice location:
  • Phone: 154-045-9110
  • Fax:
Mailing address:
  • Phone: 732-235-7674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301110553
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: