Provider Demographics
NPI:1013295070
Name:AILAWADI SURGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:AILAWADI SURGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANEESH
Authorized Official - Middle Name:
Authorized Official - Last Name:AILAWADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-955-4660
Mailing Address - Street 1:59 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-3143
Mailing Address - Country:US
Mailing Address - Phone:484-955-4660
Mailing Address - Fax:
Practice Address - Street 1:2200 HAMILTON ST STE 111
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6329
Practice Address - Country:US
Practice Address - Phone:484-934-1070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428782208600000X
2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101641970Medicaid
PA101641970Medicaid