Provider Demographics
NPI:1033792619
Name:GHANEM, YAZID KHALIL MOUSA (MD)
Entity Type:Individual
Prefix:MR
First Name:YAZID KHALIL MOUSA
Middle Name:
Last Name:GHANEM
Suffix:
Gender:M
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:APARTMENT 127 COIS LUACHRA, DOORADOYLE
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:LIMERICK
Mailing Address - Zip Code:V94 E207
Mailing Address - Country:IE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:4 MALONEY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program