Provider Demographics
NPI:1750139515
Name:HAMIDULLAH, KHADIJAH
Entity type:Individual
Prefix:
First Name:KHADIJAH
Middle Name:
Last Name:HAMIDULLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 OFFICE CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3234
Mailing Address - Country:US
Mailing Address - Phone:888-855-3019
Mailing Address - Fax:
Practice Address - Street 1:500 OFFICE CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3234
Practice Address - Country:US
Practice Address - Phone:888-855-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 374U00000X, 376J00000X, 172A00000X, 172V00000X
PARN687915163WH0200X, 163WC0200X, 163WI0500X
PAPN319971164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No172A00000XOther Service ProvidersDriver