MEDICARE: MOHAMAD KADKHODA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD034718L	PA
2	208000000X	Pediatrics Physician	MD 034718L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00025017	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	10021A	OTHER	PA	KMHP
3	5987421	OTHER	PA	AETNA PPO
4	2098859	OTHER	PA	AETNA HMO
6	114698	OTHER	PA	HIGHMARK BLUE SHIELD
7	0055553000	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1104802743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMAD KADKHODA MD

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE FL 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-926-9022
Fax Number	:	215-226-8286

Provider Business Practice Location Address
First Line	:	1300 W LEHIGH AVE
Second Line	:	SUITE B
City	:	PHILADELPHIA
State	:	PA
Zip	:	19132-2701
Country	:	US
Telephone Number	:	215-226-8800
Fax Number	:	215-226-8819

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	01/21/2020

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Directions to “ MOHAMAD KADKHODA MD” Practice Location

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