Provider Demographics
NPI:1083881635
Name:QADIR, FAYYAZ (MD)
Entity Type:Individual
Prefix:
First Name:FAYYAZ
Middle Name:
Last Name:QADIR
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 1:116 INTERSTATE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-362-8277
Mailing Address - Fax:814-368-7732
Practice Address - Street 1:406 FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749
Practice Address - Country:US
Practice Address - Phone:814-887-5655
Practice Address - Fax:814-887-1911
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN18638OtherRESIDENT PERMIT