Provider Demographics
NPI:1538406475
Name:MMFALLOUH MD LLC
Entity type:Organization
Organization Name:MMFALLOUH MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHANAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:FALLOUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-560-1104
Mailing Address - Street 1:94 NORRISTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2802
Mailing Address - Country:US
Mailing Address - Phone:989-560-1104
Mailing Address - Fax:484-448-2203
Practice Address - Street 1:6970 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2114
Practice Address - Country:US
Practice Address - Phone:484-448-2203
Practice Address - Fax:484-448-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-11
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty