Provider Demographics
NPI:1417766890
Name:RAHMAN, MOHAMMAD EKHTIAR (CRNP)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:EKHTIAR
Last Name:RAHMAN
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 HASTINGS PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-4223
Mailing Address - Country:US
Mailing Address - Phone:347-867-9094
Mailing Address - Fax:
Practice Address - Street 1:1735 HASTINGS PARK DR
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-4223
Practice Address - Country:US
Practice Address - Phone:347-867-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily