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General NPI Number Information
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NPI Number | 1760730360
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Entity Type | Organization
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Legal Business Name | WHITEHALL MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 08/29/2012
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Provider Practice Location Address
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Address Line | 525 5TH ST
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City | WHITEHALL
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State | PA
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Zip | 18052
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Country | US
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Telephone | 610-434-6678
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Fax |
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Provider Business Mailing Address
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Address Line | 525 5TH ST
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City | WHITEHALL
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State | PA
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Zip | 18052
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Country | US
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Telephone | 610-434-6678
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WAEL YACOUB
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Credential | M.D
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Telephone | 610-434-6678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD418291
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License Number State | PA
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