Basic Information
Provider Information | |||||||||
NPI: | 1336200781 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAFAR | ||||||||
FirstName: | DOUHA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 3445 | ||||||||
Address2: |   | ||||||||
City: | PITTSBURGH | ||||||||
State: | PA | ||||||||
PostalCode: | 152303445 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4129378887 | ||||||||
FaxNumber: | 4129379221 | ||||||||
Practice Location | |||||||||
Address1: | 2000 OXFORD DR | ||||||||
Address2: | SUITE 200 | ||||||||
City: | BETHEL PARK | ||||||||
State: | PA | ||||||||
PostalCode: | 151021827 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4129422140 | ||||||||
FaxNumber: | 4129426027 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/12/2006 | ||||||||
LastUpdateDate: | 02/19/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD057866L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
ID | Type | State | Issuer | Description | 7210218 | 01 | PA | AETNA | OTHER | 359694 | 01 | PA | BCBS PA | OTHER | 6126496 | 01 | PA | CIGNA | OTHER | 037335VN9 | 01 | PA | RR MEDICARE | OTHER | 103537 | 01 | PA | PA MCR GROUP PTAN | OTHER | 1523041 | 01 | PA | GATEWAY | OTHER | 101696235 | 05 | PA |   | MEDICAID |