Provider Demographics
NPI:1194818179
Name:MOSTATAB, AKBAR (MD, DPH)
Entity Type:Individual
Prefix:DR
First Name:AKBAR
Middle Name:
Last Name:MOSTATAB
Suffix:
Gender:M
Credentials:MD, DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21510 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1137
Mailing Address - Country:US
Mailing Address - Phone:610-783-7134
Mailing Address - Fax:610-783-7134
Practice Address - Street 1:21510 VALLEY FORGE CIR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1137
Practice Address - Country:US
Practice Address - Phone:610-783-7134
Practice Address - Fax:610-783-7134
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-027854-E2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11442480010Medicaid
PAE64162Medicare UPIN
PA508996Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER