Provider Demographics
NPI:1114595030
Name:PRO-HEALTH FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:PRO-HEALTH FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:SHAKHAWAT
Authorized Official - Last Name:HOSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-730-6920
Mailing Address - Street 1:1730 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1026
Mailing Address - Country:US
Mailing Address - Phone:570-813-4400
Mailing Address - Fax:570-813-4500
Practice Address - Street 1:1730 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1026
Practice Address - Country:US
Practice Address - Phone:570-813-4400
Practice Address - Fax:570-813-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty