Provider Demographics
NPI:1952651077
Name:NAQVI, SYEDA IMAMA (MD)
Entity Type:Individual
Prefix:
First Name:SYEDA
Middle Name:IMAMA
Last Name:NAQVI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SYEDA IMAMA
Other - Middle Name:
Other - Last Name:NAQVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3040
Mailing Address - Fax:215-707-8235
Practice Address - Street 1:3509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4105
Practice Address - Country:US
Practice Address - Phone:215-707-3040
Practice Address - Fax:215-707-8235
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100763207R00000X
PAMD4620152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine