Provider Demographics
NPI:1871737643
Name:JAMALDEEN, MOHAMED AZKAR (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:AZKAR
Last Name:JAMALDEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 WESTGATE DR
Mailing Address - Street 2:APT G9
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7467
Mailing Address - Country:US
Mailing Address - Phone:347-216-0086
Mailing Address - Fax:
Practice Address - Street 1:2060 WESTGATE DR
Practice Address - Street 2:APT G9
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7467
Practice Address - Country:US
Practice Address - Phone:347-216-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD444380207R00000X
VA0101251130207R00000X
NMMD2013-0087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine