Provider Demographics
NPI:1245240985
Name:TAREEN, KAMRAN (MD)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:TAREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KAM
Other - Middle Name:
Other - Last Name:TAREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:623 FOXFIELDS RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-2056
Mailing Address - Country:US
Mailing Address - Phone:215-863-6140
Mailing Address - Fax:215-492-0458
Practice Address - Street 1:2821 ISLAND AVE
Practice Address - Street 2:SUITE 264
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2300
Practice Address - Country:US
Practice Address - Phone:215-863-6140
Practice Address - Fax:215-492-0458
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050304L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015471250008Medicaid
097065Medicare ID - Type Unspecified
PA0015471250008Medicaid