Individual
MR. M YASSER GOUDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9523 BUSTLETON AVE, PHILADELPHIA, PA 19115-3801
(267) 428-6454
(267) 428-6457
Mailing address
9523 BUSTLETON AVE, PHILADELPHIA, PA 19115-3801
(267) 428-6454
(267) 428-6457
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
MD066786L
PA
208VP0014X
Interventional Pain Medicine Physician
Primary
MD066786L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001739115000
—
PA
Enumeration date
07/12/2005
Last updated
07/13/2016
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