Basic Information
| Provider Information | |||||||||
| NPI: | 1053470526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAIDER | ||||||||
| FirstName: | BUSHRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 LOTHROP ST | ||||||||
| Address2: | SUITE 9055 FORBES TOWER | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152132536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | 4126474486 | ||||||||
| Practice Location | |||||||||
| Address1: | 6502 STEUBENVILLE PIKE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152051006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127881002 | ||||||||
| FaxNumber: | 4127873475 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 01/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD423231 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000169074 | 01 | UNISON HEALTH PLAN | OTHER | 001653345 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1544126 | 01 | GATEWAY HEALTH PLAN | OTHER | 1013394100001 | 05 | PA | MEDICAID |