Healthcare Provider Details

I. General information

NPI: 1740108018
Provider Name (Legal Business Name): MUJTABA QASIM
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: MOUJAN QASIM

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S VALLEY RD
PAOLI PA
19301-1450
US

IV. Provider business mailing address

30 S VALLEY RD
PAOLI PA
19301-1450
US

V. Phone/Fax

Practice location:
  • Phone: 484-615-3155
  • Fax:
Mailing address:
  • Phone: 484-615-3155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: