Provider Demographics
NPI:1205829702
Name:JAWAD, BASIL S (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIL
Middle Name:S
Last Name:JAWAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3149 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1129
Mailing Address - Country:US
Mailing Address - Phone:610-383-1100
Mailing Address - Fax:610-383-1331
Practice Address - Street 1:3149 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1129
Practice Address - Country:US
Practice Address - Phone:610-383-1100
Practice Address - Fax:610-383-1331
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038700L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B36477Medicare UPIN