Provider Demographics
NPI:1578546792
Name:ISMAIL, SUAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUAD
Middle Name:A
Last Name:ISMAIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E NORTH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-322-2622
Mailing Address - Fax:412-322-3093
Practice Address - Street 1:490 E NORTH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-322-2622
Practice Address - Fax:412-322-3093
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068776-L207RC0000X
PAMD068776L207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019028870004Medicaid
PA058340E15OtherOTHER PROVIDER IDENTIFIER
OH2757799Medicaid
WV3810009297Medicaid
PA0019028870005Medicaid
PA058340E15Medicare PIN
PA058340NHMMedicare PIN
PAP00406190Medicare PIN
PAH61868Medicare UPIN
PA0019028870005Medicaid