Provider Demographics
NPI:1770574568
Name:MAQBOOL, FAUZIA (MD)
Entity type:Individual
Prefix:
First Name:FAUZIA
Middle Name:
Last Name:MAQBOOL
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 1:6 HEARTHSTONE CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-3065
Mailing Address - Country:US
Mailing Address - Phone:610-779-9550
Mailing Address - Fax:610-779-6433
Practice Address - Street 1:6 HEARTHSTONE CT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-3065
Practice Address - Country:US
Practice Address - Phone:610-779-9550
Practice Address - Fax:610-779-6433
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053782L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
187918JPUMedicare PIN
PAF86445Medicare UPIN