Provider Demographics
NPI:1306075148
Name:ALKHUDARI, FERAS (MD)
Entity type:Individual
Prefix:
First Name:FERAS
Middle Name:
Last Name:ALKHUDARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4527
Mailing Address - Country:US
Mailing Address - Phone:814-835-4838
Mailing Address - Fax:814-835-6938
Practice Address - Street 1:2501 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4527
Practice Address - Country:US
Practice Address - Phone:814-835-4838
Practice Address - Fax:814-835-6938
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4367602080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine