Provider Demographics
NPI:1669670535
Name:MOHYUDDIN, AYSE K (MD)
Entity Type:Individual
Prefix:DR
First Name:AYSE
Middle Name:K
Last Name:MOHYUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 N CHURCH ST
Mailing Address - Street 2:200 HAZLETON PROFESSIONAL PLAZA
Mailing Address - City:HAZLE TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18202-1480
Mailing Address - Country:US
Mailing Address - Phone:570-455-0100
Mailing Address - Fax:570-455-0177
Practice Address - Street 1:1090 N CHURCH ST
Practice Address - Street 2:200 HAZLETON PROFESSIONAL PLAZA
Practice Address - City:HAZLE TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18202-1480
Practice Address - Country:US
Practice Address - Phone:570-455-0100
Practice Address - Fax:570-455-0177
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253795207R00000X
PAMD438286207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine