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6970 Germantown Ave Philadelphia PA 19119-2114 | |
(484) 448-2203 | |
(484) 448-2203 |
Full Name | |
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Speciality | Internal Medicine |
Location | 6970 Germantown Ave, Philadelphia, Pennsylvania |
Authorized Official Name and Position | Mohanad M Fallouh (PRESIDENT) |
Authorized Official Contact | 9895601104 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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94 Norristown Rd Blue Bell PA 19422-2802 Ph: (989) 560-1104 | 6970 Germantown Ave Philadelphia PA 19119-2114 Ph: (484) 448-2203 |
NPI Number | 1538406475 |
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Provider Enumeration Date | 01/11/2013 |
Last Update Date | 10/24/2022 |
Medicare PECOS PAC ID | 4183857956 |
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Medicare Enrollment ID | O20140501000290 |
Identifier | Type | State | Issuer |
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1538406475 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | MD443377 (Pennsylvania) | Primary |
Provider Name | Mohanad M Fallouh |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619915527 PECOS PAC ID: 3971542564 Enrollment ID: I20110822000194 |
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