Provider Demographics
NPI:1013914605
Name:AL-FAKIH, MOUHANAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOUHANAD
Middle Name:
Last Name:AL-FAKIH
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 1:261 E CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3635
Mailing Address - Country:US
Mailing Address - Phone:724-628-4600
Mailing Address - Fax:724-628-0233
Practice Address - Street 1:261 E CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3635
Practice Address - Country:US
Practice Address - Phone:724-628-4600
Practice Address - Fax:724-628-0233
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2009-11-25
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
PAMD070324L207R00000X
IL036101917207R00000X
WV20249207R00000X
AZ30968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018052570003Medicaid
PAP00260640OtherRAIL ROAD MEDICARE
PA212298OtherUPMC
PA2422005OtherAETNA
PAP00260640OtherRAIL ROAD MEDICARE
H20291Medicare UPIN