Mardini, Issam A

Mardini, Issam A is an individual health care provider with primary practice located at 3400 Spruce St Hup-Dulles 6, Anesthesiology Dept, Philadelphia PA 19104-4206. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Anesthesiology, Allopathic & Osteopathic Physicians / Pain Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Mardini, Issam A can be contacted via phone (610) 416-4145.

Contact Information

Primary practice address
3400 Spruce St Hup-Dulles 6, Anesthesiology Dept Philadelphia PA 19104-4206
Phone: (610) 416-4145
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X MD060309L Pennsylvania
Allopathic & Osteopathic Physicians / Pain Medicine 207LP2900X MD060309L Pennsylvania

Profile Details

NPI number 1366439705
LBN Legal business name Mardini, Issam A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 30th, 2005
Last updated Feb 27th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366439705 NPPES
Pennsylvania MEDICAID 001753310

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