Provider Demographics
NPI:1366478927
Name:SUDDLE, NAWAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:NAWAZ
Middle Name:
Last Name:SUDDLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MOHAMMED
Other - Middle Name:N
Other - Last Name:SUDDLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:814-837-4560
Mailing Address - Fax:814-837-7905
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:814-837-4560
Practice Address - Fax:814-837-7905
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069060L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001846071Medicaid
PA034037Medicare ID - Type UnspecifiedMEDICARE
PAH07806Medicare UPIN