Provider Demographics
NPI:1801262001
Name:TRI STATE ALLERGY AND ASTHMA, LLC
Entity type:Organization
Organization Name:TRI STATE ALLERGY AND ASTHMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARTAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-688-1508
Mailing Address - Street 1:3546 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3654
Mailing Address - Country:US
Mailing Address - Phone:814-879-0979
Mailing Address - Fax:814-452-4360
Practice Address - Street 1:3546 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3654
Practice Address - Country:US
Practice Address - Phone:814-879-0979
Practice Address - Fax:814-452-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434791261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty