Provider Demographics
NPI:1316567951
Name:ELBADAWI, MAISA ELFATIH (MD)
Entity Type:Individual
Prefix:
First Name:MAISA
Middle Name:ELFATIH
Last Name:ELBADAWI
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 1:833 CHESTNUT ST STE 700
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4410
Mailing Address - Country:US
Mailing Address - Phone:215-503-3000
Mailing Address - Fax:215-503-4099
Practice Address - Street 1:12 CLOUGH DR
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-6503
Practice Address - Country:US
Practice Address - Phone:978-821-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program