Healthcare Provider Details

I. General information

NPI: 1932567013
Provider Name (Legal Business Name): MUQUEET KADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MUQUEETMOHOMED KADRI MD

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E PARK AVE STE 201
STATE COLLEGE PA
16803
US

IV. Provider business mailing address

1850 E PARK AVE STE 201
STATE COLLEGE PA
16803-6706
US

V. Phone/Fax

Practice location:
  • Phone: 814-234-8800
  • Fax: 814-235-1133
Mailing address:
  • Phone: 814-234-8800
  • Fax: 814-235-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD468379
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD468379
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: