MEDICARE: DR. MUBASHER FAZAL MD

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	207QS1201X	Sleep Medicine (Family Medicine) Physician	MD067859L	PA
2	207QS1201X	Sleep Medicine (Family Medicine) Physician	0101243795	VA
3	207Q00000X	Family Medicine Physician	D0068524	MD
4	207QS1201X	Sleep Medicine (Family Medicine) Physician	D0068524	MD
5	207RS0012X	Sleep Medicine (Internal Medicine) Physician	D0068524	MD
6	208M00000X	Hospitalist Physician	0101243795	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	196357	OTHER	VA	MEDICARE DC/FAIRFAX
3	A175	OTHER	VA	MEDICARE VA OTHER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740275551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUBASHER FAZAL MD

Provider Business Mailing Address
First Line	:	2500 W 12TH ST STE C
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4500
Country	:	US
Telephone Number	:	814-877-8730
Fax Number	:	814-877-8731

Provider Business Practice Location Address
First Line	:	2500 W 12TH ST STE C
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-4500
Country	:	US
Telephone Number	:	814-877-8730
Fax Number	:	814-877-8731

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	06/17/2022

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Directions to “ DR. MUBASHER FAZAL MD” Practice Location

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