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General NPI Number Information
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NPI Number | 1558935734
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Entity Type | Organization
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Legal Business Name | AEGIS PEDIATRICS, PLLC
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 1120 S COIT RD SUITE 20
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City | PROSPER
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State | TX
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Zip | 75078
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Country | US
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Telephone | 469-715-3899
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 S COIT RD SUITE 20
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City | PROSPER
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State | TX
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Zip | 75078
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Country | US
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Telephone | 469-715-3899
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. AHMAD EID QAWASMI
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Credential | MD
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Telephone | 203-645-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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