Basic Information
| Provider Information | |||||||||
| NPI: | 1346796091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABDELFATTAH | ||||||||
| FirstName: | THAER | ||||||||
| MiddleName: | SAQER MUSTAFA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1307 FEDERAL ST, STE B100/ALLEGHENY CENTER FOR DIGESTIV | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598900 | ||||||||
| FaxNumber: | 4123598977 | ||||||||
| Practice Location | |||||||||
| Address1: | 1307 FEDERAL ST, STE B100/ALLEGHENY CENTER FOR DIGESTIV | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123598900 | ||||||||
| FaxNumber: | 4123598977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2016 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 06/19/2019 | ||||||||
| NPIReactivationDate: | 06/27/2019 | ||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57027521 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 0116032468 | VA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.