Provider Demographics
NPI:1659468981
Name:MAKHOUL, KHALDOUN (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALDOUN
Middle Name:
Last Name:MAKHOUL
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 1:1901 HAY TER
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-4650
Mailing Address - Country:US
Mailing Address - Phone:610-438-4314
Mailing Address - Fax:610-438-4315
Practice Address - Street 1:1901 HAY TER
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-4650
Practice Address - Country:US
Practice Address - Phone:610-438-4314
Practice Address - Fax:610-438-4315
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H89293Medicare UPIN