Basic Information
| Provider Information | |||||||||
| NPI: | 1730160029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAHIR | ||||||||
| FirstName: | MAHMOOD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 N CEDAR CREST BLVD | ||||||||
| Address2: | SUITE 110B | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181042351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109731410 | ||||||||
| FaxNumber: | 6109731449 | ||||||||
| Practice Location | |||||||||
| Address1: | 451 W CHEW ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181023472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108219356 | ||||||||
| FaxNumber: | 6108219352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 09/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | MD037080L | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0006471530001 | 05 | PA | MEDICAID | 155687 | 01 | HIGHMARK BLUE SHIELD | OTHER | 0040088000 | 01 | IBC | OTHER | 7155687 | 01 | GATEWAY HEALTH PLAN | OTHER | 50048744 | 01 | CBC | OTHER | P00104383 | 01 | RR MEDICARE | OTHER | 164457 | 01 | UNISON | OTHER | 20034807 | 01 | AMERIHEALTH MERCY | OTHER |