=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922213859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAMDOUH F EL-ATTRACHE MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 06/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 E MAIN ST
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15666-2094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-547-3576
-----------------------------------------------------
Fax | 724-547-4241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 E MAIN ST
-----------------------------------------------------
City | MT PLEASANT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15666-2094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-547-3576
-----------------------------------------------------
Fax | 724-547-4241
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MAMDOUH FAWZI EL-ATTRACHE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 724-547-3576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD027815E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------