Basic Information
Provider Information | |||||||||
NPI: | 1518166818 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ATHAR | ||||||||
FirstName: | M.A | ||||||||
MiddleName: | AHAD | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ATHAR | ||||||||
OtherFirstName: | MOHAMMED | ||||||||
OtherMiddleName: | AHAD | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 911230 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 753911230 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9729978000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 5236 W UNIVERSITY DR STE 1000 | ||||||||
Address2: |   | ||||||||
City: | MCKINNEY | ||||||||
State: | TX | ||||||||
PostalCode: | 750718106 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9725428609 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/16/2007 | ||||||||
LastUpdateDate: | 10/08/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N6149 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RX0202X | N6149 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RH0003X | N6149 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | P01415856 | 01 | TX | RAILROAD MEDICARE | OTHER | 322620101 | 05 | TX |   | MEDICAID |