1548204696 NPI number — DR. MOHAMMAD BASHAR YOUSUF M.D.

Table of content: DR. MOHAMMAD BASHAR YOUSUF M.D. (NPI 1548204696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548204696 NPI number — DR. MOHAMMAD BASHAR YOUSUF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUSUF
Provider First Name:
MOHAMMAD
Provider Middle Name:
BASHAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOUSUF
Provider Other First Name:
MOHAMMAD BASHAR
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548204696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 GUTHRIE SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18840-1625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-888-5858
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
252 S 4TH ST FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17042-6111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-270-3751
Provider Business Practice Location Address Fax Number:
717-270-3754
Provider Enumeration Date:
06/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  165591-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: MD463184 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00957442 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".