Basic Information
| Provider Information | |||||||||
| NPI: | 1073586178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFIZ | ||||||||
| FirstName: | TARIQ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 E OLNEY AVE | ||||||||
| Address2: | STE 400 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191202470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154561825 | ||||||||
| FaxNumber: | 2154565926 | ||||||||
| Practice Location | |||||||||
| Address1: | 1575 N 52ND ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191314736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679304858 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD050936L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | MD050936L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 33383 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 0016428400002 | 05 | PA | MEDICAID | 0000952751 | 01 | PA | BLUE SHIELD | OTHER | 50047340 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 116993900 | 01 | PA | FEDERAL EMPLOYEES COMP | OTHER | 020301000 | 01 | PA | FEDERAL BLACK LUNG | OTHER | 110184216 | 01 | PA | RAILROAD MEDICARE PBA | OTHER | 50021738 | 01 | PA | KEYSTONE | OTHER | 0473231 | 01 | PA | US HEALTHCARE | OTHER | 0998130 | 01 | PA | KEYSTONE SPECIALIST | OTHER |