Provider Demographics
NPI:1417188251
Name:WARDEH AGHA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:WARDEH AGHA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-644-0988
Mailing Address - Street 1:7 ANTHRA PLAZA CTR
Mailing Address - Street 2:SR 61
Mailing Address - City:RANSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:17866-4199
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 ANTHRA PLAZA CTR
Practice Address - Street 2:SR 61
Practice Address - City:RANSHAW
Practice Address - State:PA
Practice Address - Zip Code:17866-4199
Practice Address - Country:US
Practice Address - Phone:570-644-0988
Practice Address - Fax:570-644-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068460L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty