Provider Demographics
NPI:1215929625
Name:ATIYEH, AHMAD M (MD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:M
Last Name:ATIYEH
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 1:325 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4554
Mailing Address - Country:US
Mailing Address - Phone:610-253-1460
Mailing Address - Fax:610-253-1830
Practice Address - Street 1:325 PINE STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4554
Practice Address - Country:US
Practice Address - Phone:610-253-1460
Practice Address - Fax:610-253-1830
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055980L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016216800001Medicaid
G69262Medicare UPIN
PA0016216800001Medicaid