Provider Demographics
NPI:1689759441
Name:RAHMAN, SHAFIQ UR (MD)
Entity Type:Individual
Prefix:
First Name:SHAFIQ
Middle Name:UR
Last Name:RAHMAN
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:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-0100
Mailing Address - Country:US
Mailing Address - Phone:570-454-2545
Mailing Address - Fax:570-454-6191
Practice Address - Street 1:116 N 5TH ST
Practice Address - Street 2:
Practice Address - City:W HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202-3946
Practice Address - Country:US
Practice Address - Phone:570-454-2545
Practice Address - Fax:570-454-6191
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053911-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015129990009Medicaid
PAG00397Medicare UPIN
PARA636316Medicare ID - Type Unspecified