Provider Demographics
NPI:1538115167
Name:EL-MALLAH, MOHAMMED GAAFAR (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:GAAFAR
Last Name:EL-MALLAH
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 1:1030 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1451
Mailing Address - Country:US
Mailing Address - Phone:610-525-3225
Mailing Address - Fax:610-525-4932
Practice Address - Street 1:1030 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:PA
Practice Address - Zip Code:19010-1451
Practice Address - Country:US
Practice Address - Phone:610-525-3225
Practice Address - Fax:610-525-4932
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054941L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG81167Medicare UPIN
PA020276TGWMedicare ID - Type Unspecified