Healthcare Provider Details

I. General information

NPI: 1073586178
Provider Name (Legal Business Name): TARIQ HAFIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N 52ND ST
PHILADELPHIA PA
19131-4736
US

IV. Provider business mailing address

101 E OLNEY AVE STE 400
PHILADELPHIA PA
19120-2470
US

V. Phone/Fax

Practice location:
  • Phone: 267-930-4858
  • Fax:
Mailing address:
  • Phone: 215-456-1825
  • Fax: 215-456-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD050936L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD050936L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: