Provider Demographics
NPI:1962714279
Name:PARKER, SAADIA KHAN (DPM)
Entity type:Individual
Prefix:
First Name:SAADIA
Middle Name:KHAN
Last Name:PARKER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 E 12TH ST
Mailing Address - Street 2:APT 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-0502
Mailing Address - Country:US
Mailing Address - Phone:256-497-0032
Mailing Address - Fax:
Practice Address - Street 1:447 E 12TH ST
Practice Address - Street 2:APT 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-0502
Practice Address - Country:US
Practice Address - Phone:256-497-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP1100X
SC629213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026857Medicaid
KYK227930Medicare PIN
TN103I483523Medicare PIN