Provider Demographics
NPI:1033527643
Name:WAFADARI R, DEENA (MD)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:
Last Name:WAFADARI R
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CENTER ST
Mailing Address - Street 2:CWEB 1, RM 1538
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-3301
Mailing Address - Country:US
Mailing Address - Phone:251-434-3915
Mailing Address - Fax:251-415-1387
Practice Address - Street 1:1700 CENTER ST
Practice Address - Street 2:CWEB 1, RM 1538
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3301
Practice Address - Country:US
Practice Address - Phone:251-434-3915
Practice Address - Fax:251-415-1387
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program