Healthcare Provider Details

I. General information

NPI: 1013996214
Provider Name (Legal Business Name): ABDUL R. WATTAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 UNIVERSITY CT
WEST CHESTER OH
45069-6542
US

IV. Provider business mailing address

2830 VICTORY PKWY CENTRAL CREDENTIALING
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-3331
  • Fax: 513-867-2667
Mailing address:
  • Phone: 513-245-3669
  • Fax: 513-475-7259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35065300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: