Provider Demographics
NPI:1104961523
Name:YASSER KHOUDEIR, MD LLC
Entity type:Organization
Organization Name:YASSER KHOUDEIR, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOUDEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-339-2156
Mailing Address - Street 1:50 N MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-1300
Mailing Address - Country:US
Mailing Address - Phone:570-339-2156
Mailing Address - Fax:570-339-2020
Practice Address - Street 1:50 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-1300
Practice Address - Country:US
Practice Address - Phone:570-339-2156
Practice Address - Fax:570-339-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061949L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016634470003Medicaid
PAG57324Medicare UPIN
PA083258Medicare PIN