Provider Demographics
NPI:1790969319
Name:KIDWAI, MOHAMMED SHOAIB JAMEEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:SHOAIB JAMEEL
Last Name:KIDWAI
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 1:4233 REMO CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2976
Mailing Address - Country:US
Mailing Address - Phone:215-639-1492
Mailing Address - Fax:
Practice Address - Street 1:333 E CITY AVE STE PL50
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1505
Practice Address - Country:US
Practice Address - Phone:610-667-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134997207R00000X, 208M00000X
KYTP985207R00000X, 208M00000X
PAMD433668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist