Provider Demographics
NPI:1770547341
Name:SAFDER, ASMA (MD)
Entity type:Individual
Prefix:
First Name:ASMA
Middle Name:
Last Name:SAFDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8845 SOUTHERN BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-5034
Mailing Address - Country:US
Mailing Address - Phone:304-952-9327
Mailing Address - Fax:
Practice Address - Street 1:1875 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4428
Practice Address - Country:US
Practice Address - Phone:304-952-9327
Practice Address - Fax:304-952-9327
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108390208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0111852000Medicaid
WVAS0715761Medicare ID - Type Unspecified
WV0111852000Medicaid