Provider Demographics
NPI:1982891388
Name:TAWADROUS, NERMINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NERMINE
Middle Name:
Last Name:TAWADROUS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 RACE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1125
Mailing Address - Country:US
Mailing Address - Phone:215-587-3122
Mailing Address - Fax:215-587-9405
Practice Address - Street 1:1513 RACE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1125
Practice Address - Country:US
Practice Address - Phone:215-587-3122
Practice Address - Fax:215-587-9405
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016921103G00000X
DEB1-0000899103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103037464-0001Medicaid
PA225652XS1Medicare PIN