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General NPI Number Information
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NPI Number | 1295947141
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Entity Type | Organization
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Legal Business Name | RAYMOND KHOUDARY MDPC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 190 S RIVER ST
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City | PLAINS
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State | PA
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Zip | 18705-1149
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Country | US
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Telephone | 570-970-1400
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Fax | 570-970-1403
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Provider Business Mailing Address
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Address Line | 190 S RIVER ST
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City | PLAINS
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State | PA
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Zip | 18705-1149
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Country | US
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Telephone | 570-970-1400
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Fax | 570-970-1403
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Authorized Official
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Title or Position | BILLING OFFICE
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Name | MRS. DEBBIE BROWN
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Credential |
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Telephone | 570-970-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MD048279L
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License Number State | PA
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