Healthcare Provider Details

I. General information

NPI: 1790607406
Provider Name (Legal Business Name): AMER JADALLAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HOSPITAL DR STE 112
STATE COLLEGE PA
16803-5500
US

IV. Provider business mailing address

143 HOSPITAL DR STE 112
STATE COLLEGE PA
16803-5500
US

V. Phone/Fax

Practice location:
  • Phone: 814-441-4851
  • Fax: 814-865-4054
Mailing address:
  • Phone: 814-441-4851
  • Fax: 814-865-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: