MEDICARE: MAKKALON EM 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	208600000X	Surgery Physician	MD455835	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD455835	OTHER	PA	PA LICENSE

General Provider Information

NPI Number	:	1801039441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAKKALON EM MD

Provider Business Mailing Address
First Line	:	761 JOHNSONBURG RD STE 240
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3480
Country	:	US
Telephone Number	:	814-781-8189
Fax Number	:	814-781-6828

Provider Business Practice Location Address
First Line	:	761 JOHNSONBURG RD STE 240
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3480
Country	:	US
Telephone Number	:	814-781-1188
Fax Number	:	814-781-6828

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

Provider Enumeration Date	:	04/13/2009
Last Update Date	:	12/12/2025

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Directions to “ MAKKALON EM MD” Practice Location

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