Healthcare Provider Details

I. General information

NPI: 1083644264
Provider Name (Legal Business Name): MUAMMAR A ARIDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SW 30TH AVE STE 101
POMPANO BEACH FL
33069-4887
US

IV. Provider business mailing address

14275 MIDWAY RD STE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 800-330-6770
  • Fax: 954-633-3217
Mailing address:
  • Phone: 336-693-4520
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number0000044637
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number200801640
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME104580
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: