Healthcare Provider Details

I. General information

NPI: 1366506263
Provider Name (Legal Business Name): NAEEM AMANULLAH PATHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 N 3RD ST
PHOENIX AZ
85012-2331
US

IV. Provider business mailing address

12145 EAST LUPINE AVE,
SCOTTSDALE AZ
85259
US

V. Phone/Fax

Practice location:
  • Phone: 602-265-8338
  • Fax: 602-265-8377
Mailing address:
  • Phone: 480-474-4779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number17016
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: