Provider Demographics
NPI:1548463797
Name:AWADA, MARC Y (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:Y
Last Name:AWADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOUWAFFAC
Other - Middle Name:YOUSSEF
Other - Last Name:AWADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1318 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2862
Mailing Address - Country:US
Mailing Address - Phone:814-746-7722
Mailing Address - Fax:
Practice Address - Street 1:135 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1559
Practice Address - Country:US
Practice Address - Phone:814-860-2304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-587-533-1OtherECFMG
MN080015883OtherMEDICARE WPS - GARRISON C
MN080015880OtherMEDICARE WPS - HOSPITAL
MN080015881OtherMEDICARE WPS - AITKIN CLI
MN996600100Medicaid
MN080015882OtherMEDICARE WPS - MCGREGOR C
MN996600100Medicaid