Healthcare Provider Details

I. General information

NPI: 1932136934
Provider Name (Legal Business Name): HAMEED AHMAD BUTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOISEY DRIVE, SUITE 214 HEALTH AND WELLNESS CENTER
HAZLETON PA
18202
US

IV. Provider business mailing address

1111 E END BLVD
WILKES BARRE PA
18711-0030
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-6900
  • Fax: 570-501-6945
Mailing address:
  • Phone: 570-824-3521
  • Fax: 570-288-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD034609L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier0005868440002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: