Provider Demographics
NPI:1588672109
Name:EMARA, MAGDI (MD)
Entity Type:Individual
Prefix:
First Name:MAGDI
Middle Name:
Last Name:EMARA
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 1:5415 E BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5417
Mailing Address - Country:US
Mailing Address - Phone:813-984-6200
Mailing Address - Fax:813-984-6066
Practice Address - Street 1:5415 E BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5417
Practice Address - Country:US
Practice Address - Phone:813-984-6200
Practice Address - Fax:813-984-6066
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41605OtherBLUE CROSS BLUE SHIELD