Provider Demographics
NPI:1952510059
Name:AL-BACHA HJAZI, IZAT KHALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:IZAT
Middle Name:KHALIL
Last Name:AL-BACHA HJAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:927 HUNTINGDON PIKE
Mailing Address - Street 2:STUITE 1
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-8373
Mailing Address - Country:US
Mailing Address - Phone:215-324-5052
Mailing Address - Fax:215-358-8399
Practice Address - Street 1:927 HUNTINGDON PIKE
Practice Address - Street 2:STUITE 1
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-8373
Practice Address - Country:US
Practice Address - Phone:215-324-5052
Practice Address - Fax:215-358-8399
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY243981207Q00000X
PAMD432731207Q00000X
DEC1-0008544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA118914Medicare PIN