Provider Demographics
NPI:1962197913
Name:BHAIYAT, MUNEER (MD)
Entity type:Individual
Prefix:MR
First Name:MUNEER
Middle Name:
Last Name:BHAIYAT
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 1:10 SHURS LANE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127
Mailing Address - Country:US
Mailing Address - Phone:215-482-1234
Mailing Address - Fax:
Practice Address - Street 1:10 SHURS LANE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19127
Practice Address - Country:US
Practice Address - Phone:215-482-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2024-01-24
Deactivation Date:2023-11-09
Deactivation Code:
Reactivation Date:2023-12-29
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT228973390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program