Provider Demographics
NPI:1184635179
Name:AL-RAWI, MOUWAFAK M (MD)
Entity Type:Individual
Prefix:
First Name:MOUWAFAK
Middle Name:M
Last Name:AL-RAWI
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 1:433 FRYE FARM RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6480
Mailing Address - Country:US
Mailing Address - Phone:724-539-0505
Mailing Address - Fax:
Practice Address - Street 1:433 FRYE FARM RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6480
Practice Address - Country:US
Practice Address - Phone:724-539-0505
Practice Address - Fax:724-532-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068209L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017695440007Medicaid
PAG62370Medicare UPIN
PA028771Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER