Provider Demographics
NPI:1558935734
Name:AEGIS PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:AEGIS PEDIATRICS, PLLC
Other - Org Name:AEGIS PEDIATRICS, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:EID
Authorized Official - Last Name:QAWASMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-645-6727
Mailing Address - Street 1:1120 S COIT RD
Mailing Address - Street 2:SUITE 20
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078
Mailing Address - Country:US
Mailing Address - Phone:469-715-3899
Mailing Address - Fax:
Practice Address - Street 1:1120 S COIT RD
Practice Address - Street 2:SUITE 20
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078
Practice Address - Country:US
Practice Address - Phone:469-715-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-13
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty