Provider Demographics
NPI:1285604488
Name:ARASTU, MOHAMMAD ISHAQ (MD,)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:ISHAQ
Last Name:ARASTU
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 1:5325 NORTHGATE DR
Mailing Address - Street 2:208
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9411
Mailing Address - Country:US
Mailing Address - Phone:610-865-6044
Mailing Address - Fax:610-865-6383
Practice Address - Street 1:5325 NORTHGATE DR
Practice Address - Street 2:208
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9411
Practice Address - Country:US
Practice Address - Phone:610-865-6044
Practice Address - Fax:610-865-6383
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019277-E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011107Medicaid
PAB41377Medicare UPIN
PA412012Medicare ID - Type Unspecified