MEDICARE: DR. MEHRUNISSA ATTARI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD050067	PA

General Provider Information

NPI Number	:	1649265257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHRUNISSA ATTARI M.D.

Provider Business Mailing Address
First Line	:	2623 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5131
Country	:	US
Telephone Number	:	215-423-2030
Fax Number	:	215-423-2344

Provider Business Practice Location Address
First Line	:	2623 E ALLEGHENY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19134-5131
Country	:	US
Telephone Number	:	215-423-2030
Fax Number	:	215-423-2344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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