Provider Demographics
NPI:1730160029
Name:TAHIR, MAHMOOD (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:
Last Name:TAHIR
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 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:451 W CHEW ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-821-9356
Practice Address - Fax:610-821-9352
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037080L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006471530001Medicaid
155687OtherHIGHMARK BLUE SHIELD
0040088000OtherIBC
7155687OtherGATEWAY HEALTH PLAN
50048744OtherCBC
P00104383OtherRR MEDICARE
164457OtherUNISON
20034807OtherAMERIHEALTH MERCY
155687OtherHIGHMARK BLUE SHIELD
PA0006471530001Medicaid