Provider Demographics
NPI:1912768367
Name:FALLATAH, WEDAD (MD, MAS, PHD)
Entity Type:Individual
Prefix:
First Name:WEDAD
Middle Name:
Last Name:FALLATAH
Suffix:
Gender:F
Credentials:MD, MAS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 N BROADWAY STE 500
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1888
Mailing Address - Country:US
Mailing Address - Phone:443-923-2999
Mailing Address - Fax:
Practice Address - Street 1:707 N BROADWAY STE 500
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1888
Practice Address - Country:US
Practice Address - Phone:443-923-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty