Provider Demographics
NPI:1508621186
Name:QDAISAT, SADEEM (CG(ASCP)MB)
Entity Type:Individual
Prefix:
First Name:SADEEM
Middle Name:
Last Name:QDAISAT
Suffix:
Gender:M
Credentials:CG(ASCP)MB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 FRANCIS STREET, COTRAN LAB BLDG 3-360
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:832-703-4672
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS STREET, COTRAN LAB BLDG, 3RD FLOOR, ROOM 360
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:832-703-4672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-14
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL49635207SC0300X, 207SG0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0203XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Molecular Genetics
No207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics