Provider Demographics
NPI:1619039914
Name:CENTER FOR KIDNEY DISEASE AND HYPERTENSION, LLC
Entity Type:Organization
Organization Name:CENTER FOR KIDNEY DISEASE AND HYPERTENSION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:FADL
Authorized Official - Last Name:ELNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-737-3377
Mailing Address - Street 1:425 N 21ST ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2223
Mailing Address - Country:US
Mailing Address - Phone:717-737-3377
Mailing Address - Fax:717-737-3387
Practice Address - Street 1:425 N 21ST ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2223
Practice Address - Country:US
Practice Address - Phone:717-737-3377
Practice Address - Fax:717-737-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045806L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA025516PZ7Medicare ID - Type Unspecified
PAB69402Medicare UPIN