Healthcare Provider Details

I. General information

NPI: 1790994929
Provider Name (Legal Business Name): ADHAM BASSAM AL HARIRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ADHAM BASSAM AL HARIRI M.D.

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 PRYTANIA ST SUITE 504
NEW ORLEANS LA
70115-3761
US

IV. Provider business mailing address

3715 PRYTANIA ST SUITE 504
NEW ORLEANS LA
70115-3761
US

V. Phone/Fax

Practice location:
  • Phone: 504-895-3223
  • Fax: 504-895-3224
Mailing address:
  • Phone: 504-895-3223
  • Fax: 504-895-3224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License NumberMD.203136
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.203136
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: