1396048286 NPI number — DR. KHALAFALLA RAHAMA MOHAMMED M.H.P

Table of content: DR. KHALAFALLA RAHAMA MOHAMMED M.H.P (NPI 1396048286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396048286 NPI number — DR. KHALAFALLA RAHAMA MOHAMMED M.H.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAMMED
Provider First Name:
KHALAFALLA
Provider Middle Name:
RAHAMA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.H.P
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOHAMMED
Provider Other First Name:
KHLAFALLA
Provider Other Middle Name:
RAHAMA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396048286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7726 FRONTENAC ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19111-3551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-214-0142
Provider Business Mailing Address Fax Number:
215-214-0142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7726 FRONTENAC ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-214-0142
Provider Business Practice Location Address Fax Number:
215-214-0142
Provider Enumeration Date:
12/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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