Skip to main content

Immune Deficiency Foundation

Find a Physician
Ask IDF
My Account
How can we help you?

Donate Make a Sustaining Gift ––>

About Primary Immunodeficiencies
Living with PI
Education and Events
Stay Informed
Get Involved
Healthcare Professionals

Search form

Search

Healthcare Professional Contact

Home / Healthcare Professional Contact

You are here

Healthcare Professional Contact

Physician Information

Constituent Type *

Medical Professional

Email *

This e-mail is for internal use only. It will not be shared publicly.

Password *

First Name *

Last Name *

Street Address *

Street Address Line 2

City *

State/Province *

Postal Code *

Country *

Secondary Language

English

Spanish

Chinese

French

Medical Professional Type *

Physician

Physician Assistant

Transplant Provider

Researcher

Pharmacist

Nurse

Nurse Practitioner

Other

Include my information in the IDF Physician Finder

Yes

No

Seeing new patients? *

Yes

No

Patient Type

Adult

Pediatric

Both

Name of Practice

Appointment Scheduling Number *

If you do not schedule appointments for patients then please provide your main contact number.

Physician Office Number

Physician Office Fax

Other Healthcare Provider

Physician Employer

Physician Job Title

Current Employer

Specialties

Specialty *

Allergy

ENT

Family Practice

Gastroenterology

Hematology

Immunology

Infectious Disease

Internal Medicine

Pediatrics

Pulmonology

Rheumatology

Other

Other Specialty *

Size of Practice

Size of Practice

Patients with PI *

Yes

No

Number of PI Patients *

Number of Patients with PI is for internal use only. This will not be shared publicly.

PI's

Specific PI's Followed

Agammaglobulinemia (XLA)

Ataxia Telangiectasia

Chronic Granulomatous Disease

Common Variable Immunodeficiency

Complement Deficiency

DiGeorge Syndrome

Hereditary Angiodema

Hyper IgE Syndrome

Hyper IgM Syndrome

Hypogammaglobulinemia

IgG Subclass Deficiency

Severe Combined Immunodeficiency

Selective IgA Deficiency

Severe Congenital Neutropenia

Specific Antibody Deficiency

Wiskott-Aldrich Syndrome

Additional PI's Followed

Credentials

Professional Memberships

Board Certifications *

Hospital Affiliation

Degree

Additional Degrees

IVIG Administered in Office

Yes

No

Additional Notes

The IDF website is supported by:

Sign-up for Updates from IDF

Sign up to receive news and helpful resources in your inbox. You can cancel at any time.

Immune Deficiency Foundation
110 West Road, Suite 300
Towson, Maryland 21204
Directions

©2019 Immune Deficiency Foundation.
Designed by BackOffice Thinking.

About IDF
Mission
History
Board of Trustees
Physician Advisory Committee
Nurse Advisory Committee
Staff Management Team
Employment Opportunities
Supporters
Policies
Reports
Contact Us
Terms of Use

Donate
Facebook
Twitter
LinkedIn
Instagram
Tumblr
IDF Friends