Healthcare Provider Details

I. General information

NPI: 1568463834
Provider Name (Legal Business Name): MOHAMAD HAKAM ALNAHHAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 CUMBERLAND AVE STE B-102
MIDDLESBORO KY
40965-2614
US

IV. Provider business mailing address

3602 CUMBERLAND AVE STE B-102 PO BOX 2898
MIDDLESBORO KY
40965-2614
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-7778
  • Fax: 606-248-7787
Mailing address:
  • Phone: 606-248-7778
  • Fax: 606-248-7787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29890
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: