Provider Demographics
NPI:1699873463
Name:SULTAN, WAMIQ (MD)
Entity type:Individual
Prefix:DR
First Name:WAMIQ
Middle Name:
Last Name:SULTAN
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 1:3241 SARUM FARM LN
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2258
Mailing Address - Country:US
Mailing Address - Phone:856-887-3005
Mailing Address - Fax:856-759-4035
Practice Address - Street 1:3241 SARUM FARM LN
Practice Address - Street 2:
Practice Address - City:GARNET VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19060-2258
Practice Address - Country:US
Practice Address - Phone:856-887-3005
Practice Address - Fax:856-759-4035
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63364207R00000X, 207RN0300X
PAMD-056420-L207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0663772000OtherAMERIHEALTH HMO
NJ19789OtherUNIVERSITY HEALTH PLAN
NJ223266219 041OtherTRICARE CHAMPUS
NJ1839600OtherUNITED HEALTHCARE
NJ7516100Medicaid
NJSA0000055OtherAMERICHOICE
NJ3364422OtherCIGNA HEALTHCARE
PA356685OtherPENNSYLVANIA BLUE SHIELD
PA356685OtherAMERIHEALTH PPO PABS
NJP1273820OtherOXFORD HEALTH CARE
NJ0595807OtherAETNA US HEALTHCARE
NJ1070758OtherHORIZON- NJ HEALTH
NJ3K6114OtherHEALTHNET, INC
NJ130018460OtherRAILROAD MEDICARE
NJSA0000055OtherAMERICHOICE
NJ223266219 041OtherTRICARE CHAMPUS