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General NPI Number Information
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NPI Number | 1154855898
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY CLINIC P.C.
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 1090 N CHURCH ST 200 HAZLETON PROFESSIONAL PLAZA
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City | HAZLE TOWNSHIP
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State | PA
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Zip | 18202-1480
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Country | US
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Telephone | 570-455-0100
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Fax | 570-455-0177
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Provider Business Mailing Address
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Address Line | 1090 N CHURCH ST 200 HAZLETON PROFESSIONAL PLAZA
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City | HAZLE TOWNSHIP
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State | PA
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Zip | 18202-1480
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Country | US
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Telephone | 570-455-0100
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Fax | 570-455-0177
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AYSE KARCA MOHYUDDIN
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Credential | MD
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Telephone | 570-455-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD438286
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License Number State | PA
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