Provider Demographics
NPI:1750424552
Name:DAYA, ISSAM AFIF (MD)
Entity type:Individual
Prefix:
First Name:ISSAM
Middle Name:AFIF
Last Name:DAYA
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 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:8601 LA SALLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2004
Practice Address - Country:US
Practice Address - Phone:410-825-6778
Practice Address - Fax:410-825-2744
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMEMBER PTAN UNKNOWNOtherMEDICARE
GAP00812883OtherRAILROAD MEDICARE
DCT854-0001OtherCAREFIRST
MDT854-0001OtherCAREFIRST