Provider Demographics
NPI:1578621835
Name:JADALI, NASSRIN (MD)
Entity Type:Individual
Prefix:DR
First Name:NASSRIN
Middle Name:
Last Name:JADALI
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 1:18 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1077
Mailing Address - Country:US
Mailing Address - Phone:215-685-5261
Mailing Address - Fax:
Practice Address - Street 1:131 E CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2153
Practice Address - Country:US
Practice Address - Phone:215-685-5733
Practice Address - Fax:215-685-5700
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041919L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1252325Medicaid
PA1252325Medicaid
PAF10984Medicare UPIN