Provider Demographics
NPI:1295947141
Name:RAYMOND KHOUDARY MDPC
Entity type:Organization
Organization Name:RAYMOND KHOUDARY MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-970-1400
Mailing Address - Street 1:190 S RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1149
Mailing Address - Country:US
Mailing Address - Phone:570-970-1400
Mailing Address - Fax:570-970-1403
Practice Address - Street 1:190 S RIVER ST
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1149
Practice Address - Country:US
Practice Address - Phone:570-970-1400
Practice Address - Fax:570-970-1403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048279L207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8954255OtherCIGNA
PA020260900OtherFEDERAL BLACK LUNG
PA4557012OtherAETNA
PA50044349OtherCBC
PA079698OtherFPH
PA333056OtherHBS
PA0031149000OtherIBC
PA23578OtherGHP
PA100260Medicare ID - Type Unspecified
PA4557012OtherAETNA