Provider Demographics
NPI:1144597261
Name:ALTAMASH I QURESHI MD PA
Entity Type:Organization
Organization Name:ALTAMASH I QURESHI MD PA
Other - Org Name:ALTAMASH I QURESHI MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTAMASH
Authorized Official - Middle Name:I
Authorized Official - Last Name:QURESHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-882-9794
Mailing Address - Street 1:2807 BORAMA DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5363
Mailing Address - Country:US
Mailing Address - Phone:314-882-9794
Mailing Address - Fax:
Practice Address - Street 1:2807 BORAMA DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5363
Practice Address - Country:US
Practice Address - Phone:314-882-9794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8559207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty