Healthcare Provider Details

I. General information

NPI: 1013018308
Provider Name (Legal Business Name): AMR ABDELGHANY KHALAFALLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CARLISLE ST
HANOVER PA
17331-1100
US

IV. Provider business mailing address

2319 SAINT MATTHEWS RD
ORANGEBURG SC
29118-2042
US

V. Phone/Fax

Practice location:
  • Phone: 717-632-4900
  • Fax: 717-632-4313
Mailing address:
  • Phone: 803-536-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28568
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD060096L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: