Provider Demographics
NPI:1538582069
Name:KAZI M ISLAM MD & ASSOCIATES
Entity type:Organization
Organization Name:KAZI M ISLAM MD & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAZI
Authorized Official - Middle Name:MONIRUL
Authorized Official - Last Name:ISLAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-394-2130
Mailing Address - Street 1:23 E LACROSSE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050
Mailing Address - Country:US
Mailing Address - Phone:610-394-2130
Mailing Address - Fax:610-394-2177
Practice Address - Street 1:23 E LA CROSSE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050
Practice Address - Country:US
Practice Address - Phone:610-394-2130
Practice Address - Fax:610-394-2177
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAZI M ISLAM MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-04
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014669110008Medicaid