Healthcare Provider Details

I. General information

NPI: 1306828421
Provider Name (Legal Business Name): EZZ ELDIN MOUKAMAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 HAYMAKER RD
MONROEVILLE PA
15146-3513
US

IV. Provider business mailing address

3824 NORTHERN PIKE SUITE 200
MONROEVILLE PA
15146
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-7618
  • Fax: 412-858-7628
Mailing address:
  • Phone: 412-457-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD417539
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD417539
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: