Provider Demographics
NPI:1366838831
Name:QDAISAT, TAREQ ZS (MD)
Entity Type:Individual
Prefix:
First Name:TAREQ
Middle Name:ZS
Last Name:QDAISAT
Suffix:
Gender:M
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:PO BOX 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-301-2018
Mailing Address - Fax:859-301-2073
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-2018
Practice Address - Fax:859-301-2073
Is Sole Proprietor?:No
Enumeration Date:2015-04-12
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01092443A207ZP0102X
KYTP529207ZP0102X
KY57980207ZP0102X
NE32402207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology