Provider Demographics
NPI:1225181811
Name:MEMON, PARVEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVEZ
Middle Name:
Last Name:MEMON
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:ROUTE 611 STROUD BLDG
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9317
Mailing Address - Country:US
Mailing Address - Phone:570-420-5435
Mailing Address - Fax:570-420-5437
Practice Address - Street 1:208 LIFELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-6473
Practice Address - Country:US
Practice Address - Phone:570-420-5435
Practice Address - Fax:570-420-5437
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058888L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015887180007Medicaid
PA0015887180007Medicaid
PA892421Medicare ID - Type Unspecified