Provider Demographics
NPI:1104980820
Name:KHALIFA, SUHA F (MD)
Entity type:Individual
Prefix:DR
First Name:SUHA
Middle Name:F
Last Name:KHALIFA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:421 W CHEW ST
Mailing Address - Street 2:PHYSICIAN ACCOUNTS
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3406
Mailing Address - Country:US
Mailing Address - Phone:610-776-5100
Mailing Address - Fax:610-663-3113
Practice Address - Street 1:3570 HAMILTON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4512
Practice Address - Country:US
Practice Address - Phone:610-433-7481
Practice Address - Fax:610-433-3991
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD430371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2808320000OtherIBC
1937588OtherHIGHMARK BLUE SHIELD
50065437OtherCBC
PA1018626210001Medicaid
P008307OtherGATEWAY HEALTH PLAN
50065437OtherCBC
PAI70734Medicare UPIN