Provider Demographics
NPI:1629631114
Name:MAZYAD, WARD TAWFEEK
Entity Type:Individual
Prefix:
First Name:WARD
Middle Name:TAWFEEK
Last Name:MAZYAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WARD
Other - Middle Name:TAWFEEK MAZYAD
Other - Last Name:AL DABBOOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:559 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4250
Mailing Address - Country:US
Mailing Address - Phone:484-622-0959
Mailing Address - Fax:
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-0959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
PAMT2216662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program