Healthcare Provider Details

I. General information

NPI: 1073956611
Provider Name (Legal Business Name): HUMA SHUJA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 KIDSPEACE DR
OREFIELD PA
18069-2044
US

IV. Provider business mailing address

5300 KIDSPEACE DR
OREFIELD PA
18069-2044
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-8853
  • Fax: 610-799-8001
Mailing address:
  • Phone: 610-799-8853
  • Fax: 610-799-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD445951
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier103067276-0001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: