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General NPI Number Information
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NPI Number | 1538406475
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Entity Type | Organization
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Legal Business Name | MMFALLOUH MD LLC
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 6970 GERMANTOWN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19119-2114
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Country | US
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Telephone | 484-448-2203
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Fax | 484-448-2203
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Provider Business Mailing Address
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Address Line | 94 NORRISTOWN RD
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City | BLUE BELL
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State | PA
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Zip | 19422-2802
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Country | US
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Telephone | 989-560-1104
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Fax | 484-448-2203
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHANAD M FALLOUH
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Credential | M.D.
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Telephone | 989-560-1104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD443377
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License Number State | PA
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