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1619915527

NPI Code Detail

MEDICARE: MOHANAD M FALLOUH M.D.

MEDICARE: MOHANAD M FALLOUH M.D.

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	4301083048	MI
2	207R00000X	Internal Medicine Physician	MD443377	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	440771	OTHER	PA	MLHC MEDICARE AA #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1103710361	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1018503	OTHER	MI	MCLAREN HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	01005838	OTHER	MI	HEALTHPLUS COMMERCIAL
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1020183	OTHER	MI	MCLAREN HEALTH PLAN
9	200000005731	OTHER	MI	PHP COMMERCIAL
10	440771	OTHER	PA	MLHC BCBS AA #
11	1016406	OTHER	MI	MCLAREN HEALTH PLAN

General Provider Information

NPI Number	:	1619915527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHANAD M FALLOUH M.D.

Provider Business Mailing Address
First Line	:	6950 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2114
Country	:	US
Telephone Number	:	484-443-4406
Fax Number	:	484-448-2203

Provider Business Practice Location Address
First Line	:	6950 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2120
Country	:	US
Telephone Number	:	484-443-4406
Fax Number	:	484-448-2203

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/04/2023

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Directions to “ MOHANAD M FALLOUH M.D.” Practice Location

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