Provider Demographics
NPI:1366506263
Name:PATHAN, NAEEM AMANULLAH (MD)
Entity Type:Individual
Prefix:DR
First Name:NAEEM
Middle Name:AMANULLAH
Last Name:PATHAN
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 1:12145 EAST LUPINE AVE,
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259
Mailing Address - Country:US
Mailing Address - Phone:480-474-4779
Mailing Address - Fax:
Practice Address - Street 1:3450 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2331
Practice Address - Country:US
Practice Address - Phone:602-265-8338
Practice Address - Fax:602-265-8377
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ170162084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry