Healthcare Provider Details

I. General information

NPI: 1558979872
Provider Name (Legal Business Name): MIAN TANVEER UD DIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E NORTH AVE
PITTSBURGH PA
15212-4772
US

IV. Provider business mailing address

7 ALLEGHENY CTR APT 507
PITTSBURGH PA
15212-5213
US

V. Phone/Fax

Practice location:
  • Phone: 412-359-3166
  • Fax:
Mailing address:
  • Phone: 412-726-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT220684
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: