MEDICARE: MMFALLOUH MD LLC

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	207R00000X	Internal Medicine Physician	MD443377	PA

General Provider Information

NPI Number	:	1538406475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MMFALLOUH MD LLC

Provider Business Mailing Address
First Line	:	94 NORRISTOWN RD
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-2802
Country	:	US
Telephone Number	:	989-560-1104
Fax Number	:	484-448-2203

Provider Business Practice Location Address
First Line	:	6970 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2114
Country	:	US
Telephone Number	:	484-448-2203
Fax Number	:	484-448-2203

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHANAD M FALLOUH
Credential	:	M.D.
Telephone Number	:	989-560-1104

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	10/24/2022

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