Provider Demographics
NPI:1235611005
Name:ABUALSOUD, AHMAD ISSAM MAHMOUD (MBBCH)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:ISSAM MAHMOUD
Last Name:ABUALSOUD
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 HIGH POINT BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7817
Mailing Address - Country:US
Mailing Address - Phone:610-866-5555
Mailing Address - Fax:610-866-3151
Practice Address - Street 1:3445 HIGH POINT BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7817
Practice Address - Country:US
Practice Address - Phone:610-866-5555
Practice Address - Fax:610-866-3151
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD207Y00000X
PAMD473596207YP0228X, 207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program