Healthcare Provider Details

I. General information

NPI: 1003879412
Provider Name (Legal Business Name): QAMAR U SHAIKH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 US HIGHWAY 82 W STE 3&4
TIFTON GA
31793-8200
US

IV. Provider business mailing address

140 WAYLAND SMITH DR
UNIONTOWN PA
15401-2677
US

V. Phone/Fax

Practice location:
  • Phone: 229-445-3509
  • Fax: 229-445-3513
Mailing address:
  • Phone: 724-437-9854
  • Fax: 724-437-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD425344
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82203
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: