Provider Demographics
NPI:1699877399
Name:KENAWY, AZZA EZZEL-ARAB (MD)
Entity type:Individual
Prefix:
First Name:AZZA
Middle Name:EZZEL-ARAB
Last Name:KENAWY
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 1:1511 MCDANIEL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-430-0111
Mailing Address - Fax:610-430-3676
Practice Address - Street 1:1511 MCDANIEL DRIVE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380
Practice Address - Country:US
Practice Address - Phone:610-430-0111
Practice Address - Fax:610-430-3676
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063270L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1706517Medicaid
PA1706517Medicaid
G60048Medicare UPIN