Provider Demographics
NPI:1619597747
Name:ASQUITH, ABDUL M
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:M
Last Name:ASQUITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LOGAN SQ STE 300
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2733
Mailing Address - Country:US
Mailing Address - Phone:267-897-5317
Mailing Address - Fax:267-363-1908
Practice Address - Street 1:2 LOGAN SQ STE 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2733
Practice Address - Country:US
Practice Address - Phone:267-897-5317
Practice Address - Fax:267-363-1908
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
PA251T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care