1679637409 NPI number — DR. ATIRA RAHMAN MD

Table of content: DR. ATIRA RAHMAN MD (NPI 1679637409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679637409 NPI number — DR. ATIRA RAHMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHMAN
Provider First Name:
ATIRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679637409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 W CHEW ST
Provider Second Line Business Mailing Address:
PHYSICIAN ACCOUNTS
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18102-3406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-776-5100
Provider Business Mailing Address Fax Number:
610-663-3113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 W CHEW ST
Provider Second Line Business Practice Location Address:
SIGAL CENTER 2ND FLOOR
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18102-3434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-776-5160
Provider Business Practice Location Address Fax Number:
610-606-4457
Provider Enumeration Date:
12/19/2006

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: 208000000X , with the licence number:  MD425097 , 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: 1925006 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CAPITAL BLUE CROSS . This is a "50065416" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2793782000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P008305 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1018415970001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000200056 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: AMERIHEALTH MERCY . This is a "20058816" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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