Provider Demographics
NPI:1710938246
Name:LATEEF, MUJAHED BUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MUJAHED
Middle Name:BUD
Last Name:LATEEF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:BUD
Other - Last Name:LATEEF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 13166
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-0166
Mailing Address - Country:US
Mailing Address - Phone:412-446-6172
Mailing Address - Fax:
Practice Address - Street 1:110 ROESSLER RD STE 100D
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1014
Practice Address - Country:US
Practice Address - Phone:412-466-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4219972081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012616590002Medicaid
PADO3361Medicare PIN
PA1012616590002Medicaid
PA1012616590002Medicaid