Provider Demographics
NPI:1518129923
Name:ELFATAH, MAHMOUD (MD)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ELFATAH
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 1:828 PROVIDENCE RD
Mailing Address - Street 2:APT C303
Mailing Address - City:SECANE
Mailing Address - State:PA
Mailing Address - Zip Code:19018-3638
Mailing Address - Country:US
Mailing Address - Phone:610-457-1129
Mailing Address - Fax:
Practice Address - Street 1:828 PROVIDENCE RD
Practice Address - Street 2:APT C303
Practice Address - City:SECANE
Practice Address - State:PA
Practice Address - Zip Code:19018-3638
Practice Address - Country:US
Practice Address - Phone:215-762-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 1893732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry