Provider Demographics
NPI:1598824054
Name:ELIZABETH FAMILY MEDICINE
Entity Type:Organization
Organization Name:ELIZABETH FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BUSHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-384-0008
Mailing Address - Street 1:121 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-1532
Mailing Address - Country:US
Mailing Address - Phone:412-384-0008
Mailing Address - Fax:412-384-5640
Practice Address - Street 1:121 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-1532
Practice Address - Country:US
Practice Address - Phone:412-384-0008
Practice Address - Fax:412-384-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013394100001Medicaid
3805946OtherAETNA
P00219230OtherRAILROAD MEDICARE
PA1738084OtherHIGHMARK BLUE SHIELD
PA1738084OtherHIGHMARK BLUE SHIELD