Provider Demographics
NPI:1831132513
Name:HAMDALLAH, KHADIJAH AHKAD
Entity Type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:AHKAD
Last Name:HAMDALLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9021
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9021
Mailing Address - Country:US
Mailing Address - Phone:787-272-6432
Mailing Address - Fax:787-272-6432
Practice Address - Street 1:AVE. MONSERRATE AA5 ESQ. FIDALGO DIAZ
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-769-4034
Practice Address - Fax:787-272-6432
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11668208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087784Medicare ID - Type Unspecified
PRG42141Medicare UPIN