1619915527 NPI number — MOHANAD M FALLOUH M.D.

Table of content: MOHANAD M FALLOUH M.D. (NPI 1619915527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619915527 NPI number — MOHANAD M FALLOUH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALLOUH
Provider First Name:
MOHANAD
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619915527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6950 GERMANTOWN AVE
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:
19119-2114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-443-4406
Provider Business Mailing Address Fax Number:
484-448-2203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6950 GERMANTOWN AVE
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:
19119-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-443-4406
Provider Business Practice Location Address Fax Number:
484-448-2203
Provider Enumeration Date:
06/03/2006

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: 207R00000X , with the licence number:  4301083048 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD443377 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1103710361 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4847475-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1018503 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 440771 . This is a "MLHC MEDICARE AA #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4732682-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01005838 . This is a "HEALTHPLUS COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4885019-10 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1020183 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000005731 . This is a "PHP COMMERCIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 440771 . This is a "MLHC BCBS AA #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1016406 . This is a "MCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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