Healthcare Provider Details

I. General information

NPI: 1518031228
Provider Name (Legal Business Name): SYED F QADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOISEY DRIVE SUITE 206
HAZLETON PA
18202
US

IV. Provider business mailing address

PO BOX 1347
KINGSTON PA
18704-0347
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-6899
  • Fax: 570-501-6897
Mailing address:
  • Phone: 570-288-8881
  • Fax: 570-288-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD430379
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier821523
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerFIRST PRIORITY HEALTH
# 2
Identifier1019568440001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier001941893
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: