Healthcare Provider Details

I. General information

NPI: 1972583847
Provider Name (Legal Business Name): AHMAD NABATCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BROOKVILLE ST
FAIRMOUNT CITY PA
16224-1101
US

IV. Provider business mailing address

1323 BROOKVILLE ST
FAIRMOUNT CITY PA
16224-1101
US

V. Phone/Fax

Practice location:
  • Phone: 814-275-3320
  • Fax: 814-275-4413
Mailing address:
  • Phone: 814-275-3320
  • Fax: 814-275-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD016123E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: