MEDICARE: DR. PARVEZ MEMON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD058888L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225181811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PARVEZ MEMON M.D.

Provider Business Mailing Address
First Line	:	ROUTE 611 STROUD BLDG
Second Line	:	SUITE 100B
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-9317
Country	:	US
Telephone Number	:	570-420-5435
Fax Number	:	570-420-5437

Provider Business Practice Location Address
First Line	:	208 LIFELINE RD STE 102
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6473
Country	:	US
Telephone Number	:	570-420-5435
Fax Number	:	570-420-5437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	01/26/2023

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