Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD445313 | PA |
N | 111NI0900X | Internist | MD445313 | PA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD445313 | PA |
NPI | 1043400567 |
---|---|
Provider Name | Mona Al Mukaddam |
First Address | Philadelphia, PA 19104-5134 |
Second Address | Philadelphia, PA 19104-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 21/01/2016 |