Provider Demographics
NPI:1164988317
Name:QADAR, XAVIER S (MS)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:S
Last Name:QADAR
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50190
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-0190
Mailing Address - Country:US
Mailing Address - Phone:260-760-8877
Mailing Address - Fax:
Practice Address - Street 1:205 THREE RIVERS N
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-1301
Practice Address - Country:US
Practice Address - Phone:260-760-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral