Healthcare Provider Details

I. General information

NPI: 1265928063
Provider Name (Legal Business Name): USAMA IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N 15TH ST FL 6
PHILADELPHIA PA
19102
US

IV. Provider business mailing address

245 N 15TH ST FL 6
PHILADELPHIA PA
19102-1198
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-6900
  • Fax: 215-762-4231
Mailing address:
  • Phone: 215-762-6900
  • Fax: 215-762-4231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT216266
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: