Provider Demographics
NPI:1568982247
Name:BADER, SOUMAYA (DPM)
Entity Type:Individual
Prefix:
First Name:SOUMAYA
Middle Name:
Last Name:BADER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SOUMAYA
Other - Middle Name:
Other - Last Name:BADR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2023 GREENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2964
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:632 CEDAR RD STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-8376
Practice Address - Country:US
Practice Address - Phone:757-547-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301296213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery