Healthcare Provider Details

I. General information

NPI: 1861012742
Provider Name (Legal Business Name): NATASHA QUTAB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 TECHNOLOGY PKWY STE 400
MECHANICSBURG PA
17050-9413
US

IV. Provider business mailing address

2005 TECHNOLOGY PKWY STE 400
MECHANICSBURG PA
17050-9413
US

V. Phone/Fax

Practice location:
  • Phone: 717-791-2520
  • Fax: 717-703-0061
Mailing address:
  • Phone: 717-791-2520
  • Fax: 717-703-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberMD483945
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD483945
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: