Healthcare Provider Details

I. General information

NPI: 1295383586
Provider Name (Legal Business Name): FATIMA MOHAMMAD NABI TIK MOHAMMAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3995
US

IV. Provider business mailing address

3104 SARATOGA LN
NORRISTOWN PA
19403-6321
US

V. Phone/Fax

Practice location:
  • Phone: 610-447-2000
  • Fax:
Mailing address:
  • Phone: 267-678-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLT000836
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: