Provider Demographics
NPI:1346363041
Name:BASIL JAWAD,M .D.
Entity Type:Organization
Organization Name:BASIL JAWAD,M .D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAWAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-383-1100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008733880006Medicaid
PA1025763OtherKEYSTONE MERCY
PA110007674OtherRAIL ROAD MEDICARE
PA102698OtherPA BLUE SHIELD
PA0026142001OtherPERSONAL CHOICE
PA=========OtherTAX ID
PA=========OtherTAX ID
PA1025763OtherKEYSTONE MERCY