Provider Demographics
NPI:1073956611
Name:SHUJA, HUMA (MD)
Entity Type:Individual
Prefix:
First Name:HUMA
Middle Name:
Last Name:SHUJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 KIDSPEACE DR
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-2044
Mailing Address - Country:US
Mailing Address - Phone:610-799-8853
Mailing Address - Fax:610-799-8001
Practice Address - Street 1:5300 KIDSPEACE DR
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-2044
Practice Address - Country:US
Practice Address - Phone:610-799-8853
Practice Address - Fax:610-799-8001
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103067276-0001Medicaid