Healthcare Provider Details

I. General information

NPI: 1699873463
Provider Name (Legal Business Name): WAMIQ SULTAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 SARUM FARM LN
GARNET VALLEY PA
19060-2258
US

IV. Provider business mailing address

3241 SARUM FARM LN
GARNET VALLEY PA
19060-2258
US

V. Phone/Fax

Practice location:
  • Phone: 856-887-3005
  • Fax: 856-759-4035
Mailing address:
  • Phone: 856-887-3005
  • Fax: 856-759-4035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA63364
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-056420-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD-056420-L
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMA63364
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: