Provider Demographics
NPI:1053068809
Name:WHITE SQUARE VASCULAR SURGERY PA
Entity Type:Organization
Organization Name:WHITE SQUARE VASCULAR SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU-GHAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-255-4750
Mailing Address - Street 1:5233 KING AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2324 W JOPPA RD STE 100
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4617
Practice Address - Country:US
Practice Address - Phone:410-918-1525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies