Provider Demographics
NPI:1982457321
Name:WHITE SQUARE VASCULAR SURGERY PA
Entity Type:Organization
Organization Name:WHITE SQUARE VASCULAR SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NBIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABU-GHAIDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-918-1525
Mailing Address - Street 1:5233 KING AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4003
Mailing Address - Country:US
Mailing Address - Phone:141-091-8152
Mailing Address - Fax:410-918-1525
Practice Address - Street 1:8817 BELAIR RD STE 109
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-2445
Practice Address - Country:US
Practice Address - Phone:410-870-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty