Healthcare Provider Details

I. General information

NPI: 1932720307
Provider Name (Legal Business Name): MOHAMMAD ASIM AMJAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LACKAWANNA AVE STE 220
SCRANTON PA
18503-2001
US

IV. Provider business mailing address

2100 MACK BLVD FL 4
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-7864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD494896
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: