Healthcare Provider Details

I. General information

NPI: 1053254458
Provider Name (Legal Business Name): RENA ATAYEVA M.D.
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: RENA GASIMOVA ATAYEVA M.D.

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2255
  • Fax:
Mailing address:
  • Phone: 484-526-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT236093
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: