Individual
ISSAM A MARDINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, HUP-DULLES 6, ANESTHESIOLOGY DEPT, PHILADELPHIA, PA 19104-4206
(610) 416-4145
Mailing address
3400 SPRUCE ST, HUP-DULLES 6, ANESTHESIOLOGY DEPT, PHILADELPHIA, PA 19104-4206
(610) 416-4145
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD060309L
PA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD060309L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001753310
—
PA
Enumeration date
09/30/2005
Last updated
02/27/2012
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