Provider Demographics
NPI:1073561585
Name:MAKHOUL, NAHLA (MD)
Entity Type:Individual
Prefix:
First Name:NAHLA
Middle Name:
Last Name:MAKHOUL
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 1:1407 EISENHOWER BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3262
Mailing Address - Country:US
Mailing Address - Phone:814-269-1494
Mailing Address - Fax:814-266-8572
Practice Address - Street 1:1407 EISENHOWER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3262
Practice Address - Country:US
Practice Address - Phone:814-269-1494
Practice Address - Fax:814-266-8572
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD428262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I51577Medicare UPIN