Provider Demographics
NPI:1649230855
Name:SYED, MUSHTAQ ALI (MD)
Entity type:Individual
Prefix:DR
First Name:MUSHTAQ
Middle Name:ALI
Last Name:SYED
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 1:1265 WAYNE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-463-1048
Mailing Address - Fax:724-463-1049
Practice Address - Street 1:1265 WAYNE AVE STE 103
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-463-1048
Practice Address - Fax:724-463-1049
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33330207RE0101X
PAMD060866L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021506810001Medicaid
AZ32624300Medicaid
PA136956Medicare PIN
PA1021506810001Medicaid
AZ32624300Medicaid