Basic Information
| Provider Information | |||||||||
| NPI: | 1013232966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | MIRZA | ||||||||
| MiddleName: | IJAZ | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 WINDERMERE DR | ||||||||
| Address2: | |||||||||
| City: | BLUE BELL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194221450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4849953966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 850 GERMANTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194622400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102753884 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2010 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD070032L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 2083P0901X | MD070032L | PA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
No ID Information.