Provider Demographics
NPI:1437125895
Name:WATTOO, MUHAMMAD AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:AHMAD
Last Name:WATTOO
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 1:2359 N TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1059
Mailing Address - Country:US
Mailing Address - Phone:607-257-3452
Mailing Address - Fax:607-257-3612
Practice Address - Street 1:2359 N TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1059
Practice Address - Country:US
Practice Address - Phone:607-257-3452
Practice Address - Fax:607-257-3612
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065400L207R00000X
NY218549-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017424600001Medicaid
NY01944852Medicaid
NY01944852Medicaid
PA025806N8QMedicare ID - Type Unspecified
NYRB5737Medicare PIN