Healthcare Provider Details

I. General information

NPI: 1801039441
Provider Name (Legal Business Name): MAKKALON EM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 JOHNSONBURG RD STE 240
SAINT MARYS PA
15857-3480
US

IV. Provider business mailing address

761 JOHNSONBURG RD STE 240
SAINT MARYS PA
15857-3480
US

V. Phone/Fax

Practice location:
  • Phone: 814-781-1188
  • Fax: 814-781-6828
Mailing address:
  • Phone: 814-781-8189
  • Fax: 814-781-6828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD455835
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: