Provider Demographics
NPI: | 1255508149 |
---|---|
Name: | ATHAR, MUHAMMAD WAQAS (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MUHAMMAD |
Middle Name: | WAQAS |
Last Name: | ATHAR |
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: | 10506A MONTGOMERY RD STE 300 |
Mailing Address - Street 2: | |
Mailing Address - City: | MONTGOMERY |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45242-4402 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-246-2400 |
Mailing Address - Fax: | 513-246-4047 |
Practice Address - Street 1: | 10506A MONTGOMERY RD STE 300 |
Practice Address - Street 2: | |
Practice Address - City: | MONTGOMERY |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45242-4402 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-246-2400 |
Practice Address - Fax: | 513-246-4047 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-05-11 |
Last Update Date: | 2023-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | D72498 | 207R00000X |
OH | 35.130616 | 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | 043858800 | Medicaid | |
OH | 0231531 | Medicaid |