Provider Demographics
NPI:1053387415
Name:MAKKAOUI, TALAL AHMAD (MD)
Entity type:Individual
Prefix:
First Name:TALAL
Middle Name:AHMAD
Last Name:MAKKAOUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 NORTH STREET
Mailing Address - Street 2:SUITE 413
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-447-2555
Mailing Address - Fax:413-443-7039
Practice Address - Street 1:725 NORTH STREET
Practice Address - Street 2:BERKSHIRE MEDICAL CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-447-2555
Practice Address - Fax:413-443-7039
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA77440207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13582OtherBS
MA3115852Medicaid
F52877Medicare UPIN
MA3115852Medicaid