Provider Demographics
NPI:1639240344
Name:RIFKAH, ELIAS MOUNIF (MD)
Entity Type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:MOUNIF
Last Name:RIFKAH
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 1:120 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4926
Mailing Address - Country:US
Mailing Address - Phone:814-940-8113
Mailing Address - Fax:814-946-1928
Practice Address - Street 1:120 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4926
Practice Address - Country:US
Practice Address - Phone:814-940-8113
Practice Address - Fax:814-946-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066020L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA008060OtherMEDICARE PTAB NUMBER
PA0017622580005Medicaid
F57672Medicare UPIN