Provider Demographics
NPI:1033190335
Name:MAHMOOD TAHIR MD
Entity Type:Organization
Organization Name:MAHMOOD TAHIR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-821-9356
Mailing Address - Street 1:451 W CHEW ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3472
Mailing Address - Country:US
Mailing Address - Phone:610-821-9356
Mailing Address - Fax:610-821-9352
Practice Address - Street 1:451 W CHEW ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-821-9356
Practice Address - Fax:610-821-9352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037080L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006471530001Medicaid
1611199OtherHIGHMARK BLUE SHIELD
DB4336OtherRR MEDICARE
20034805OtherAMERIHEALTH MERCY
2290077000OtherIBC
7990819OtherGATEWAY HEALTH PLAN
50042307OtherCBC
PA0006471530001Medicaid