Provider Demographics
NPI:1881653657
Name:SULTAN, JUNAID (MD)
Entity Type:Individual
Prefix:
First Name:JUNAID
Middle Name:
Last Name:SULTAN
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 1:421 CHEW ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:602 E 21ST ST # B
Practice Address - Street 2:SUITE 400
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1259
Practice Address - Country:US
Practice Address - Phone:610-262-1519
Practice Address - Fax:610-262-7125
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37314207R00000X
PAMD432045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370382Medicaid
1983995OtherHIGHMARK BLUE SHIELD
P008931OtherGATEWAY HEALTH PLAN
50072127OtherCBC
PA1020042170001Medicaid
2861836000OtherIBC
P008931OtherGATEWAY HEALTH PLAN
TN3883901Medicare ID - Type Unspecified
TN3370382Medicaid
PA116505E6FMedicare PIN