Provider Demographics
NPI:1376757609
Name:SATTAR, SHARIQ (MD)
Entity type:Individual
Prefix:
First Name:SHARIQ
Middle Name:
Last Name:SATTAR
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 1:1351 N ZARAGOZA RD BLDG F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7902
Mailing Address - Country:US
Mailing Address - Phone:915-202-4469
Mailing Address - Fax:
Practice Address - Street 1:1351 N ZARAGOZA RD BLDG F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7902
Practice Address - Country:US
Practice Address - Phone:915-202-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125007207R00000X
OH35.89272207R00000X
PAMD432937207R00000X
TXQ4840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102042110Medicaid
PA102042110Medicaid