Provider Demographics
NPI:1497083968
Name:AMAN, MUSTAFA WAHABREBBI (MD)
Entity Type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:WAHABREBBI
Last Name:AMAN
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:317 W LOCKHART ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1618
Practice Address - Country:US
Practice Address - Phone:570-887-3920
Practice Address - Fax:570-887-3929
Is Sole Proprietor?:No
Enumeration Date:2009-11-22
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281798208600000X
PAMD455752208600000X
MDD78063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030610850001Medicaid
PA442208N8SMedicare PIN
PA1030610850001Medicaid