Provider Demographics
NPI:1356345748
Name:BITTAR, BASSAM FAIZ (MD)
Entity type:Individual
Prefix:MR
First Name:BASSAM
Middle Name:FAIZ
Last Name:BITTAR
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 1:564 W. BROAD ST.
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201
Mailing Address - Country:US
Mailing Address - Phone:570-501-6400
Mailing Address - Fax:570-453-2353
Practice Address - Street 1:564 W. BROAD ST.
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201
Practice Address - Country:US
Practice Address - Phone:570-501-6400
Practice Address - Fax:570-453-2353
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-06-20
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-06-23
Provider Licenses
StateLicense IDTaxonomies
PAMD-056973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016887960001Medicaid
PA001961OtherFIRST PRIORITY HEALTH ID#
PABI813177OtherBLUE CROSS BLUE SHIELD
PA813177Medicare ID - Type Unspecified
PA0016887960001Medicaid