Basic Information
Provider Information | |||||||||
NPI: | 1750424552 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAYA | ||||||||
FirstName: | ISSAM | ||||||||
MiddleName: | AFIF | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8110 MAPLE LAWN BLVD STE 235 | ||||||||
Address2: |   | ||||||||
City: | FULTON | ||||||||
State: | MD | ||||||||
PostalCode: | 207592694 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3013408339 | ||||||||
FaxNumber: | 3013409027 | ||||||||
Practice Location | |||||||||
Address1: | 8601 LA SALLE RD | ||||||||
Address2: | SUITE 102 | ||||||||
City: | TOWSON | ||||||||
State: | MD | ||||||||
PostalCode: | 212862004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4108256778 | ||||||||
FaxNumber: | 4108252744 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/14/2007 | ||||||||
LastUpdateDate: | 03/31/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/31/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0033938 | MD | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | P00812883 | 01 | GA | RAILROAD MEDICARE | OTHER | T854-0001 | 01 | MD | CAREFIRST | OTHER | MEMBER PTAN UNKNOWN | 01 | MD | MEDICARE | OTHER | T854-0001 | 01 | DC | CAREFIRST | OTHER |