Provider Demographics
NPI:1740519479
Name:ISSAM DAYA MD PA
Entity type:Organization
Organization Name:ISSAM DAYA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:AFIF
Authorized Official - Last Name:DAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-825-6778
Mailing Address - Street 1:8601 LA SALLE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2004
Mailing Address - Country:US
Mailing Address - Phone:410-825-6778
Mailing Address - Fax:410-825-2744
Practice Address - Street 1:8601 LA SALLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2004
Practice Address - Country:US
Practice Address - Phone:410-825-6778
Practice Address - Fax:410-825-2744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCT854-0001OtherCAREFIRST
GADQ0837OtherRAILROAD MEDICARE
MDT854-0001OtherCAREFIRST
MD166388OtherMEDICARE