Provider Demographics
NPI:1487605176
Name:JAMEEL, MUSHTAQ (MD)
Entity type:Individual
Prefix:DR
First Name:MUSHTAQ
Middle Name:
Last Name:JAMEEL
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 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-267-7480
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:176 S COLDBROOK AVENUE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2714
Practice Address - Country:US
Practice Address - Phone:717-267-7480
Practice Address - Fax:717-267-7427
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4218972084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00377938OtherRAILROAD MEDICARE
PA25-1716306OtherDEVON
PA7796813OtherAETNA NON-HMO
PA1282351OtherAETNA HMO
PA1572649OtherGATEWAY
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherGREATWEST
PA25-1716306OtherINFORMED
PA25-1716306OtherINTERGROUP
PAJA1789404OtherHIGHMARK BLUE SHIELD
PA101540403 0002Medicaid
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherHEALTHNET/TRICARE
PA50060241OtherCAPITAL BLUECROSS
PAG920-0053/KDM4CUOtherCAREFIRST
PAMD421897OtherLICENSE NUMBER
PA5702486OtherFIRST HEALTH
PA5702486OtherFIRST HEALTH
PAG920-0053/KDM4CUOtherCAREFIRST
PA103200LN7Medicare PIN