Provider Demographics
NPI:1720136096
Name:A. RASID MAKHDOMI, M.D.,P.C.
Entity Type:Organization
Organization Name:A. RASID MAKHDOMI, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:A.
Authorized Official - Middle Name:RASHID
Authorized Official - Last Name:MAKHDOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-253-9854
Mailing Address - Street 1:2100 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3830
Mailing Address - Country:US
Mailing Address - Phone:610-253-9854
Mailing Address - Fax:610-253-2484
Practice Address - Street 1:2100 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3830
Practice Address - Country:US
Practice Address - Phone:610-253-9854
Practice Address - Fax:610-253-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033411L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143147OtherPABS
PA50574OtherAETNA
PA02999300OtherCAIC
PA000617299000Medicaid
PA143147OtherPABS
143147Medicare ID - Type Unspecified