Provider Demographics
NPI:1518160803
Name:QAISAR, MUZAMMIL M (DO)
Entity Type:Individual
Prefix:
First Name:MUZAMMIL
Middle Name:M
Last Name:QAISAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:3998 RED LION RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1436
Practice Address - Country:US
Practice Address - Phone:215-612-4088
Practice Address - Fax:215-612-4323
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013924207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019198870001Medicaid
PA1019198870002Medicaid
PA30042545OtherKEYSTONE MERCY
PA2849149000OtherPERSONAL CHOICE
PA2849149000OtherKEYSTONE, IBC
PA01697OtherHEALTH PARTNERS - TC
PA1019198870003Medicaid
PA1967239OtherHIGHMARK BLUE SHIELD
PA30563OtherHEALTH PARTNERS FF
PA1019198870002Medicaid