=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366122855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AZZ MEDCAL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2023
-----------------------------------------------------
Last Update Date | 11/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 WALNUT LN
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-890-1050
-----------------------------------------------------
Fax | 609-890-0950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 WALNUT LN
-----------------------------------------------------
City | YARDLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19067-2000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-890-1050
-----------------------------------------------------
Fax | 609-890-0950
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAHID MEER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 609-943-8806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------