Provider Demographics
NPI:1932720307
Name:AMJAD, MOHAMMAD ASIM (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD ASIM
Middle Name:
Last Name:AMJAD
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:THE WRIGHT CENTER FOR GRADUATE MEDICAL EDUCATION
Mailing Address - Street 2:501 S. WASHINGTON AVENUE
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505
Mailing Address - Country:US
Mailing Address - Phone:570-343-2383
Mailing Address - Fax:570-343-4800
Practice Address - Street 1:6431 FANNIN ST.
Practice Address - Street 2:SUITE MSB 1.255E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:832-325-7222
Practice Address - Fax:713-500-6829
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program