Provider Demographics
NPI:1285666008
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU-GHAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-918-1525
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-3113
Practice Address - Street 1:5233 KING AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4003
Practice Address - Country:US
Practice Address - Phone:410-918-1525
Practice Address - Fax:410-918-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD462105100OtherMEDICAL ASSISTANCE
GADF0610OtherRAILROAD MEDICARE
DC4490OtherCAREFIRST DC
MD09QSAMOtherCAREFIRST MD
DC4490OtherCAREFIRST DC