Provider Demographics
NPI:1982706982
Name:MOHIUDDIN, MANZOOR NAYEEMA (MD)
Entity type:Individual
Prefix:MRS
First Name:MANZOOR
Middle Name:NAYEEMA
Last Name:MOHIUDDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-7920
Mailing Address - Country:US
Mailing Address - Phone:215-947-5745
Mailing Address - Fax:215-487-4328
Practice Address - Street 1:5800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1737
Practice Address - Country:US
Practice Address - Phone:215-487-4718
Practice Address - Fax:215-487-4328
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028414-E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0023040000OtherHMO ID
PAC34342Medicare UPIN
PA456931Medicare ID - Type Unspecified