Basic Information
| Provider Information | |||||||||
| NPI: | 1972568368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAMAN | ||||||||
| FirstName: | MUMTAZ | ||||||||
| MiddleName: | U | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2608 KEISER BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106855864 | ||||||||
| FaxNumber: | 6109299395 | ||||||||
| Practice Location | |||||||||
| Address1: | 2608 KEISER BLVD | ||||||||
| Address2: | |||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196103333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106855864 | ||||||||
| FaxNumber: | 6109299395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 03/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MD447205 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 21881 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 21881 | WV | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | MD447205 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 64100761 | 05 | KY | MEDICAID | 2549755 | 05 | OH | MEDICAID | 3810002152 | 05 | WV | MEDICAID |