Healthcare Provider Details

I. General information

NPI: 1134474000
Provider Name (Legal Business Name): KAMAL KHALAF M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 HILLCREST DR
PUNXSUTAWNEY PA
15767-2605
US

IV. Provider business mailing address

122 ASPEN RD
PUNXSUTAWNEY PA
15767-2658
US

V. Phone/Fax

Practice location:
  • Phone: 814-938-1836
  • Fax:
Mailing address:
  • Phone: 814-938-8051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD038962L
License Number StatePA

VIII. Authorized Official

Name: DR. KAMAL KHALAF
Title or Position: OWNER
Credential: M.D.
Phone: 814-938-8051