Provider Demographics
NPI:1083664247
Name:TEJPAR, MOHAMED K (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:K
Last Name:TEJPAR
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 1:2602 WILMINGTON RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1537
Mailing Address - Country:US
Mailing Address - Phone:724-658-6583
Mailing Address - Fax:724-658-6081
Practice Address - Street 1:2602 WILMINGTON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1537
Practice Address - Country:US
Practice Address - Phone:724-658-6583
Practice Address - Fax:724-658-6081
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035830L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069059OtherBLUE SHIELD
PA0007308030004Medicaid
PA110217120OtherMEDICARE TRAVELERS
PA069059XGPMedicare PIN
PA0007308030004Medicaid