Provider Demographics
NPI:1295957470
Name:WASSEF, SHERIF BOTROS MIKHAIL (MD MS FRCS)
Entity type:Individual
Prefix:
First Name:SHERIF
Middle Name:BOTROS MIKHAIL
Last Name:WASSEF
Suffix:
Gender:M
Credentials:MD MS FRCS
Other - Prefix:
Other - First Name:SHERIF
Other - Middle Name:BOTROS
Other - Last Name:MIKHAIL WASSEF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MS FRCS
Mailing Address - Street 1:241 LOWREY PL APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-3017
Mailing Address - Country:US
Mailing Address - Phone:860-655-4037
Mailing Address - Fax:860-666-4932
Practice Address - Street 1:241 LOWREY PL APT 4
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-3017
Practice Address - Country:US
Practice Address - Phone:860-655-4037
Practice Address - Fax:860-666-4932
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069654L2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102112804Medicaid
PA111236OtherGEISINGER HEALTH PLAN
PA212423OtherJOHNS HOPKINS
PA1570603OtherGATEWAY-WMG
PA2026993OtherHIGHMARK BLUE SHIELD
PA7440881OtherAETNA
MD919374OtherCAREFIRST MD BCBS
WVH80972Medicare UPIN