Provider Demographics
NPI:1285627232
Name:MUKHTYAR, USHA D (MD)
Entity Type:Individual
Prefix:DR
First Name:USHA
Middle Name:D
Last Name:MUKHTYAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1521 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3151
Mailing Address - Country:US
Mailing Address - Phone:718-863-2173
Mailing Address - Fax:718-823-3926
Practice Address - Street 1:1521 BENSON ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3101
Practice Address - Country:US
Practice Address - Phone:718-863-2173
Practice Address - Fax:718-823-3926
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY110284207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY711152Medicare PIN