Individual
DAVID PETER MOUALLEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4 E MAIN ST, NANTICOKE, PA 18634-1602
(570) 735-7474
(570) 735-2921
Mailing address
4 E MAIN ST, NANTICOKE, PA 18634-1602
(570) 258-3939
(570) 258-0165
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS007906L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015426480004
—
PA
01
—
002460
FIRST PRIORITY HEALTH
PA
01
—
020017400
BLACK LUNG
PA
01
—
129122
HEALTH AMERICA
PA
01
—
20815
GEISINGER HEALTH PLAN
PA
01
—
787165
HIGHMARK BLUE SHIELD
PA
Enumeration date
05/18/2006
Last updated
10/19/2021
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