Provider Demographics
NPI:1447621347
Name:MEKKAOUI, SUMAYA (MD)
Entity type:Individual
Prefix:DR
First Name:SUMAYA
Middle Name:
Last Name:MEKKAOUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-4331
Mailing Address - Country:US
Mailing Address - Phone:610-447-6254
Mailing Address - Fax:610-447-6276
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-447-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-18
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464878207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0705535Medicaid
PA1035233030001Medicaid
PAMD464878OtherMEDICAL LICENSE