Provider Demographics
NPI:1437119294
Name:EASTON FAMILY PRACTICE P.C
Entity Type:Organization
Organization Name:EASTON FAMILY PRACTICE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALDOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-438-4314
Mailing Address - Street 1:1901 HAY TER
Mailing Address - Street 2:SUITE# 5
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4650
Mailing Address - Country:US
Mailing Address - Phone:610-438-4314
Mailing Address - Fax:610-438-4315
Practice Address - Street 1:1901 HAY TER
Practice Address - Street 2:SUITE# 5
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4650
Practice Address - Country:US
Practice Address - Phone:610-438-4314
Practice Address - Fax:610-438-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89293Medicare UPIN