Provider Demographics
NPI:1184682890
Name:JADALI, SEYEDMEHDI (MD)
Entity type:Individual
Prefix:DR
First Name:SEYEDMEHDI
Middle Name:
Last Name:JADALI
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 1:324 E MAIN ST
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7150
Mailing Address - Country:US
Mailing Address - Phone:302-737-4990
Mailing Address - Fax:302-737-5082
Practice Address - Street 1:324 E MAIN ST
Practice Address - Street 2:SUITE # 204
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7150
Practice Address - Country:US
Practice Address - Phone:302-737-4990
Practice Address - Fax:302-737-5082
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1007528208D00000X
DEC10007528208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1184682890Medicaid
PA102892714 0001Medicaid
DE14467500OtherDEPARTMENT OF LABOR
MD253405300Medicaid
DE1184682890Medicaid
DE14467500OtherDEPARTMENT OF LABOR