Provider Demographics
NPI:1508175969
Name:QURESHI, MAHREEN R
Entity Type:Individual
Prefix:
First Name:MAHREEN
Middle Name:R
Last Name:QURESHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FAYETTE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1347
Mailing Address - Country:US
Mailing Address - Phone:610-304-2662
Mailing Address - Fax:
Practice Address - Street 1:1412 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2908
Practice Address - Country:US
Practice Address - Phone:215-684-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2024-04-02
Deactivation Date:2023-11-08
Deactivation Code:
Reactivation Date:2024-03-29
Provider Licenses
StateLicense IDTaxonomies
PASP028533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily