Provider Demographics
NPI:1255361325
Name:EWIDA, ASHRAFE (MD)
Entity type:Individual
Prefix:
First Name:ASHRAFE
Middle Name:
Last Name:EWIDA
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:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4088
Practice Address - Fax:215-612-4323
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072505L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01697OtherHEALTH PARTNERS
PA0018865220012Medicaid
PA01886522-05OtherAMERICHOICE
PA1342327OtherHIGHMARK BLUE SHIELD
PA1342327OtherPERSONAL CHOICE
PA0018865220011Medicaid
PA2034803000OtherKEYSTONE IBC
PA2869121OtherCIGNA
PA3056444OtherAETNA CONTRACT
PA0018865220010Medicaid
PA30015027OtherKEYSTONE MERCY
PA050040RDBMedicare PIN
PAH45239Medicare UPIN