Provider Demographics
NPI:1063414829
Name:QAYYUM, AZMAT (MD)
Entity type:Individual
Prefix:
First Name:AZMAT
Middle Name:
Last Name:QAYYUM
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 1:204 VILLA MANOR DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3313
Mailing Address - Country:US
Mailing Address - Phone:412-687-5573
Mailing Address - Fax:412-687-8854
Practice Address - Street 1:5131 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2217
Practice Address - Country:US
Practice Address - Phone:412-687-5573
Practice Address - Fax:412-687-8854
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-073585-L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050899F08Medicare ID - Type Unspecified
PAG16154Medicare UPIN