Provider Demographics
NPI:1851418164
Name:ALKHAFAJI, IKBAL (MD)
Entity Type:Individual
Prefix:
First Name:IKBAL
Middle Name:
Last Name:ALKHAFAJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 HUNTERS PASS DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635-8357
Mailing Address - Country:US
Mailing Address - Phone:814-696-1666
Mailing Address - Fax:
Practice Address - Street 1:203 HUNTERS PASS DR
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635-8357
Practice Address - Country:US
Practice Address - Phone:814-696-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067821L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G81221Medicare UPIN