Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101059235 | VA |
NPI | 1164425500 |
---|---|
Provider Name | Iyad S Saidi |
First Address | Baltimore, MD 21297-1334 |
Second Address | Alexandria, VA 22310-3247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 29/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164425500 | (05) | VA |
G76001 | (02) | |
P00807167 | RR MEDICARE (01) | DC |