Provider Demographics
NPI:1043400567
Name:AL MUKADDAM, MONA (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:AL MUKADDAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 CIVIC CENTER BLVD.
Mailing Address - Street 2:WEST PAVILION, 4TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5134
Mailing Address - Country:US
Mailing Address - Phone:215-662-2300
Mailing Address - Fax:215-614-0418
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:WEST PAVILION, 4TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5134
Practice Address - Country:US
Practice Address - Phone:215-662-2300
Practice Address - Fax:215-614-0418
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445313207RE0101X, 207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine