Provider Demographics
NPI:1073586178
Name:HAFIZ, TARIQ (MD)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:HAFIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:STE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:1575 N 52ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4736
Practice Address - Country:US
Practice Address - Phone:267-930-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050936L207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA33383OtherGEISINGER HEALTH PLAN
PA0016428400002Medicaid
PA0000952751OtherBLUE SHIELD
PA50047340OtherCAPITAL BLUE CROSS
PA116993900OtherFEDERAL EMPLOYEES COMP
PA020301000OtherFEDERAL BLACK LUNG
PA110184216OtherRAILROAD MEDICARE PBA
PA50021738OtherKEYSTONE
PA0473231OtherUS HEALTHCARE
PA0998130OtherKEYSTONE SPECIALIST
PA110184216OtherRAILROAD MEDICARE PBA
PA50047340OtherCAPITAL BLUE CROSS