Provider Demographics
NPI:1952407710
Name:PASHA, TANVIR AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:TANVIR
Middle Name:AHMAD
Last Name:PASHA
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 1:1122 OPAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5940
Mailing Address - Country:US
Mailing Address - Phone:301-791-0212
Mailing Address - Fax:301-393-3880
Practice Address - Street 1:1122 OPAL CT
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5940
Practice Address - Country:US
Practice Address - Phone:301-791-0212
Practice Address - Fax:301-393-3880
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35497207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD480711100Medicaid
MD480711100Medicaid
C49286Medicare UPIN