Basic Information
| Provider Information | |||||||||
| NPI: | 1598851768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDUL-HAKEEM | ||||||||
| FirstName: | FATIMA | ||||||||
| MiddleName: | FATIHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106198590 | ||||||||
| FaxNumber: | 6106198591 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | UPLAND | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133958 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106198590 | ||||||||
| FaxNumber: | 6106198591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 05/20/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD429199 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1017410450001 | 05 | PA | MEDICAID | 1017410450002 | 05 | PA | MEDICAID | 1017410450003 | 05 | PA | MEDICAID | 2862398000 | 01 | PA | BCBS - PA | OTHER | 2088899 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |