Provider Demographics
NPI:1801039441
Name:EM, MAKKALON (MD)
Entity type:Individual
Prefix:
First Name:MAKKALON
Middle Name:
Last Name:EM
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 1:761 JOHNSONBURG RD STE 240
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3480
Mailing Address - Country:US
Mailing Address - Phone:814-781-8189
Mailing Address - Fax:814-781-6828
Practice Address - Street 1:761 JOHNSONBURG RD STE 240
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3480
Practice Address - Country:US
Practice Address - Phone:814-781-1188
Practice Address - Fax:814-781-6828
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2025-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455835208600000X
MEMD20797208600000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD455835OtherPA LICENSE