Provider Demographics
NPI:1346275666
Name:FATIMA, SUMAYYA (MD)
Entity Type:Individual
Prefix:
First Name:SUMAYYA
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SHELBYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2601
Mailing Address - Country:US
Mailing Address - Phone:317-782-1577
Mailing Address - Fax:888-366-7577
Practice Address - Street 1:5150 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2601
Practice Address - Country:US
Practice Address - Phone:317-782-1577
Practice Address - Fax:888-366-7577
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425164207R00000X
IN01061443A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFA1928165OtherHIGHMARK BLUE SHIELD - BUCKS/LOWER BUCKS
PA102291840 0001Medicaid
PA30060503OtherKEYSTONE MERCY-LOWER BUCKS GROUP
PA096307ZDKTMedicare PIN
PA102291840 0001Medicaid
PA096307ZCHMMedicare PIN