Provider Demographics
NPI:1922053388
Name:RIFAI, MUHAMAD ALY (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMAD ALY
Middle Name:
Last Name:RIFAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1360
Mailing Address - Street 2:BLUE MOUNTAIN PSYCHIATRY LLC
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18044-1360
Mailing Address - Country:US
Mailing Address - Phone:610-829-5089
Mailing Address - Fax:484-898-0334
Practice Address - Street 1:241 N 13TH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3211
Practice Address - Country:US
Practice Address - Phone:610-253-2500
Practice Address - Fax:833-225-9075
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431055207R00000X, 207RA0401X, 2084P0015X, 2084P0805X, 2084P0800X
MDD0060990209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101931809Medicaid
PA113284KZHMedicare UPIN