Provider Demographics
NPI:1497718902
Name:MAKHDOMI, ABDUL RASHID (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:RASHID
Last Name:MAKHDOMI
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 1:2100 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3830
Mailing Address - Country:US
Mailing Address - Phone:610-253-9854
Mailing Address - Fax:610-253-2484
Practice Address - Street 1:2100 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3830
Practice Address - Country:US
Practice Address - Phone:610-253-9854
Practice Address - Fax:610-253-2484
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033411L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000617299Medicaid
PA143147OtherHIGHMARK BLUE SHIELD
PA50574OtherAETNA
PA000617299000Medicaid
PA0050645000OtherINDEPENDENCE BLUE CROSS
PA01139201OtherCAIC
PA143147OtherPABS
PA50088726OtherCAPITAL BLUE CROSS
PA01139201OtherCAIC
PA50574OtherAETNA
PA000617299000Medicaid
PA143147Medicare PIN