Provider Demographics
NPI:1730159450
Name:EFFAT, MAHMOUD KAMAL (MD)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:KAMAL
Last Name:EFFAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MAHMOUD
Other - Middle Name:KAMAL
Other - Last Name:EFFAT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:108 JOHN ROBERT THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-363-0907
Mailing Address - Fax:610-363-8097
Practice Address - Street 1:108 JOHN ROBERT THOMAS DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-0907
Practice Address - Fax:610-363-8097
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032780E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B34312Medicare UPIN
PA046729Medicare ID - Type Unspecified