Provider Demographics
NPI:1538297270
Name:KOURY, JADD WADI (MD)
Entity Type:Individual
Prefix:
First Name:JADD
Middle Name:WADI
Last Name:KOURY
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 1:3907 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1536
Mailing Address - Country:US
Mailing Address - Phone:717-232-4567
Mailing Address - Fax:717-232-8152
Practice Address - Street 1:3907 N FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1536
Practice Address - Country:US
Practice Address - Phone:717-232-4567
Practice Address - Fax:717-232-8152
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD036495208600000X
NJ25MA07859100208C00000X
PAMD438866208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102860953Medicaid