Provider Demographics
NPI:1245214089
Name:MURTAZA, MOHAMMED (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:
Last Name:MURTAZA
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 1:370 MIDDLETOWN BLVD
Mailing Address - Street 2:STE510
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1840
Mailing Address - Country:US
Mailing Address - Phone:215-750-6566
Mailing Address - Fax:215-750-7288
Practice Address - Street 1:370 MIDDLETOWN BLVD
Practice Address - Street 2:STE510
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1840
Practice Address - Country:US
Practice Address - Phone:215-750-6566
Practice Address - Fax:215-750-7288
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026618174400000X
PAMD433927174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO674259OtherHEALTHLINK
AR155783001Medicaid
MO191066OtherBLUE CROSS BLUE SHIELD
MO209310002Medicaid
MO209310002Medicaid
MOI07077Medicare UPIN
AR155783001Medicaid
MO917802993Medicare ID - Type Unspecified
PA132110Medicare PIN