Provider Demographics
NPI:1235271560
Name:HANI J TUFFAHA MD PC
Entity Type:Organization
Organization Name:HANI J TUFFAHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANI
Authorized Official - Middle Name:JAWDAT
Authorized Official - Last Name:TUFFAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-323-5352
Mailing Address - Street 1:904 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3166
Mailing Address - Country:US
Mailing Address - Phone:570-323-5352
Mailing Address - Fax:570-323-1066
Practice Address - Street 1:904 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3166
Practice Address - Country:US
Practice Address - Phone:570-323-5352
Practice Address - Fax:570-323-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027307E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072141OtherFIRST PRIORITY HEALTH
PA03021000OtherCAPITAL BLUE CROSS
PA0008780520001Medicaid
PA072141OtherFIRST PRIORITY HEALTH
PA0008780520001Medicaid