Provider Demographics
NPI:1578680708
Name:TADROS, WAGIH F (MD)
Entity Type:Individual
Prefix:DR
First Name:WAGIH
Middle Name:F
Last Name:TADROS
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 1:63 W PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5705
Mailing Address - Country:US
Mailing Address - Phone:732-651-8118
Mailing Address - Fax:732-651-9797
Practice Address - Street 1:63 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5705
Practice Address - Country:US
Practice Address - Phone:732-651-8118
Practice Address - Fax:732-651-9797
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA51212207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0366307Medicaid
NJF09093Medicare UPIN
NJ0366307Medicaid