Provider Demographics
NPI:1508158130
Name:KIDWAI, ATTIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ATTIYA
Middle Name:
Last Name:KIDWAI
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 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1101 EDGAR ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2862
Practice Address - Country:US
Practice Address - Phone:717-851-1500
Practice Address - Fax:717-851-1515
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4545842084P0800X, 2084P0800X
MI53150499662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427574G9BMedicare PIN
PA427574EZ3Medicare PIN