Provider Demographics
NPI:1083815732
Name:DAHODWALA, NABILA A (MD)
Entity type:Individual
Prefix:
First Name:NABILA
Middle Name:A
Last Name:DAHODWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 9TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6103
Mailing Address - Country:US
Mailing Address - Phone:215-829-6708
Mailing Address - Fax:215-829-6606
Practice Address - Street 1:330 S 9TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6103
Practice Address - Country:US
Practice Address - Phone:215-829-6708
Practice Address - Fax:215-829-6606
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4292102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11908972Medicaid
PA50069705OtherCAPITAL BLUE CROSS