Provider Demographics
NPI:1013018308
Name:KHALAFALLAH, AMR ABDELGHANY (MD)
Entity Type:Individual
Prefix:
First Name:AMR
Middle Name:ABDELGHANY
Last Name:KHALAFALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 SAINT MATTHEWS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2042
Mailing Address - Country:US
Mailing Address - Phone:803-536-1571
Mailing Address - Fax:
Practice Address - Street 1:1150 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1100
Practice Address - Country:US
Practice Address - Phone:717-632-4900
Practice Address - Fax:717-632-4313
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC285682084P0800X
PAMD060096L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016673100003Medicaid
SC327877Medicaid
PAG02920Medicare UPIN
SC327877Medicaid
PA0016673100003Medicaid