MEDICARE: NABILA A DAHODWALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD429210	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	50069705	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1083815732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NABILA A DAHODWALA MD

Provider Business Mailing Address
First Line	:	330 S 9TH ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6103
Country	:	US
Telephone Number	:	215-829-6708
Fax Number	:	215-829-6606

Provider Business Practice Location Address
First Line	:	330 S 9TH ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6103
Country	:	US
Telephone Number	:	215-829-6708
Fax Number	:	215-829-6606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	08/07/2014

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