Healthcare Provider Details

I. General information

NPI: 1306115738
Provider Name (Legal Business Name): AHMED MOH'D ABDEL LATIF YASSIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3471 5TH AVE SUITE 811
PITTSBURGH PA
15213-3215
US

IV. Provider business mailing address

3471 5TH AVE SUITE 811
PITTSBURGH PA
15213-3215
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-1277
  • Fax: 412-624-2302
Mailing address:
  • Phone: 412-624-1277
  • Fax: 412-624-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number210004
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: