Basic Information
| Provider Information | |||||||||
| NPI: | 1558337105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 620 HOWARD AVE | ||||||||
| Address2: | ALTOONA REGIONAL HEALTH SYSTEM | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148892223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 HOWARD AVE | ||||||||
| Address2: | OP 302 | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148892011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 02/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD056603L | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001575943004 | 05 | PA | MEDICAID |