Provider Demographics
NPI:1730494584
Name:KAAWACH, WAEL FAYEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:WAEL
Middle Name:FAYEZ
Last Name:KAAWACH
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 1:197 8TH ST
Mailing Address - Street 2:APPT 215
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-4208
Mailing Address - Country:US
Mailing Address - Phone:617-241-0755
Mailing Address - Fax:
Practice Address - Street 1:197 8TH ST
Practice Address - Street 2:APPT 215
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-4208
Practice Address - Country:US
Practice Address - Phone:617-241-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161307174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist