Provider Demographics
NPI:1902851983
Name:IRFAN, M ANJUM (MD)
Entity Type:Individual
Prefix:
First Name:M ANJUM
Middle Name:
Last Name:IRFAN
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 1:917 GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4368
Mailing Address - Country:US
Mailing Address - Phone:610-719-0530
Mailing Address - Fax:
Practice Address - Street 1:103 S HIGH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-3262
Practice Address - Country:US
Practice Address - Phone:610-719-0530
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048218L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2638628000OtherMHS
PW1826702OtherBLUE SHIELD
PA0013983570010Medicaid
PW1826702OtherBLUE SHIELD
PA137459Medicare ID - Type Unspecified