Provider Demographics
NPI:1821552670
Name:BADWAN, OSAMAH ZAYED (MD)
Entity Type:Individual
Prefix:
First Name:OSAMAH
Middle Name:ZAYED
Last Name:BADWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OSAMAH
Other - Middle Name:ZAYED
Other - Last Name:BADWAN MUSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-1512
Mailing Address - Country:US
Mailing Address - Phone:787-435-4746
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-2724
Practice Address - Country:US
Practice Address - Phone:216-444-2336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57.251185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program