Provider Demographics
NPI:1932136934
Name:BUTT, HAMEED AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:HAMEED
Middle Name:AHMAD
Last Name:BUTT
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 1:1111 E END BLVD
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18711-0030
Mailing Address - Country:US
Mailing Address - Phone:570-824-3521
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:50 MOISEY DRIVE, SUITE 214
Practice Address - Street 2:HEALTH AND WELLNESS CENTER
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-501-6900
Practice Address - Fax:570-501-6945
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034609L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005868440002Medicaid
131988LMUMedicare ID - Type Unspecified
PA0005868440002Medicaid