Provider Demographics
NPI:1265548499
Name:EL MALLAH, MAI KAMAL (MD)
Entity type:Individual
Prefix:DR
First Name:MAI
Middle Name:KAMAL
Last Name:EL MALLAH
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:CHILDREN'S HEALTH CENTER
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-0001
Mailing Address - Country:US
Mailing Address - Phone:919-684-3960
Mailing Address - Fax:919-684-2292
Practice Address - Street 1:CHC ERWIN ROAD DUKE UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710
Practice Address - Country:US
Practice Address - Phone:919-684-8657
Practice Address - Fax:919-684-2292
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258806208000000X, 2080P0214X
FLME1143662080P0214X
NC2256532080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177152901Medicaid
MAS400170191OtherMEDICARE
FL007206400Medicaid
MA110100625AMedicaid
FL007206400Medicaid
TXI47500Medicare UPIN
TX177152901Medicaid