Healthcare Provider Details

I. General information

NPI: 1497195267
Provider Name (Legal Business Name): MOHAMMAD F PATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MCKIAN AVE
CHARLEROI PA
15022
US

IV. Provider business mailing address

PO BOX 212
CHARLEROI PA
15022
US

V. Phone/Fax

Practice location:
  • Phone: 724-483-8065
  • Fax: 724-565-5110
Mailing address:
  • Phone: 724-483-8065
  • Fax: 724-565-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number06303
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberRS2016-0706
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD461967
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: