Basic Information
| Provider Information | |||||||||
| NPI: | 1205070026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUHAMMAD IKRAM, MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 383 WYOMING AVE | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187043637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702888881 | ||||||||
| FaxNumber: | 5702888065 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 179212147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708752000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2009 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | IKRAM | ||||||||
| AuthorizedOfficialFirstName: | MUHAMMAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5708752000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD418986 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1477731180 | 01 | PA | TYPE 1 NPI | OTHER |