Provider Demographics
NPI:1407311806
Name:KAMAL, HAROON
Entity Type:Individual
Prefix:
First Name:HAROON
Middle Name:
Last Name:KAMAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W RITTENHOUSE SQ APT 2208
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5704
Mailing Address - Country:US
Mailing Address - Phone:267-768-8600
Mailing Address - Fax:
Practice Address - Street 1:222 W RITTENHOUSE SQ APT 2208
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-5704
Practice Address - Country:US
Practice Address - Phone:267-768-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-10
Last Update Date:2019-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103587703-0001374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103587703-0001Medicaid