Provider Demographics
NPI:1093775108
Name:FOAD, WAFAA (MD)
Entity Type:Individual
Prefix:
First Name:WAFAA
Middle Name:
Last Name:FOAD
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 1:7730 MONTGOMERY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4284
Mailing Address - Country:US
Mailing Address - Phone:513-984-4565
Mailing Address - Fax:513-984-5470
Practice Address - Street 1:7730 MONTGOMERY RD STE 200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-4284
Practice Address - Country:US
Practice Address - Phone:513-984-4565
Practice Address - Fax:513-984-5470
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611949Medicaid
OH9316611Medicare ID - Type Unspecified
OH0611949Medicaid