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General NPI Number Information
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NPI Number | 1326216995
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Entity Type | Organization
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Legal Business Name | M AZAM MOHIUDDIN MD PC
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 8110 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2803
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Country | US
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Telephone | 215-695-0331
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Fax |
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Provider Business Mailing Address
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Address Line | 8110 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19152-2803
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Country | US
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Telephone | 215-695-0331
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | M AZAM MOHIUDDIN
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Credential | MD PC
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Telephone | 215-695-0331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | MD037150L
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License Number State | PA
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