Healthcare Provider Details

I. General information

NPI: 1245263656
Provider Name (Legal Business Name): SADIA MUFTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 BUCK RD STE 106
SOUTHAMPTON PA
18966-1748
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 215-322-1919
  • Fax: 215-322-2875
Mailing address:
  • Phone: 215-456-1825
  • Fax: 215-456-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD429382
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: