Individual
DR. M HOSSEIN ETEZADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 CENTRAL AVE, SUITE 102, MALVERN, PA 19355-3219
(610) 296-0142
(610) 651-2880
Mailing address
325 CENTRAL AVE, SUITE 102, MALVERN, PA 19355-3219
(610) 296-0142
(610) 651-2880
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
MD031576L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009930090007
—
PA
05
—
0009930090008
—
PA
05
—
0009930090009
—
PA
01
—
232359401
GREAT VALLEY HEALTH
PA
Enumeration date
01/13/2006
Last updated
07/09/2007
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