Provider Demographics
NPI:1487036265
Name:HATHIDARA, MAUSAMINBEN YUNUSALI (MD)
Entity type:Individual
Prefix:
First Name:MAUSAMINBEN
Middle Name:YUNUSALI
Last Name:HATHIDARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 NE 53RD ST APT 2709
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1862
Mailing Address - Country:US
Mailing Address - Phone:832-781-9433
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE STE E3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4817
Practice Address - Country:US
Practice Address - Phone:814-889-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD469442084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology