Provider Demographics
NPI:1295726305
Name:AKHTAR, RIFFAT (MD)
Entity type:Individual
Prefix:DR
First Name:RIFFAT
Middle Name:
Last Name:AKHTAR
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 1:106 SO CLAUDE A. LORD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3637
Mailing Address - Country:US
Mailing Address - Phone:570-622-4209
Mailing Address - Fax:570-622-1386
Practice Address - Street 1:106 SO CLAUDE A. LORD BOULEVARD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3637
Practice Address - Country:US
Practice Address - Phone:570-622-4209
Practice Address - Fax:570-622-1386
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059634L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA014582OtherHIGHMARK
PA1651052Medicaid
PA50082265OtherCAPITAL BLUE CROSS
PA391893OtherFQHC
PA1007288440033Medicaid
PA50082265OtherCAPITAL BLUE CROSS
001131Medicare PIN