Healthcare Provider Details

I. General information

NPI: 1932192945
Provider Name (Legal Business Name): DAFER W AL-HADDADIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAFER W HADDADIN MD

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BORTHWICK AVE STE 202
PORTSMOUTH NH
03801-7156
US

IV. Provider business mailing address

155 BORTHWICK AVE STE 202
PORTSMOUTH NH
03801-7156
US

V. Phone/Fax

Practice location:
  • Phone: 603-434-8733
  • Fax: 603-433-8834
Mailing address:
  • Phone: 603-434-8733
  • Fax: 603-433-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2008004909
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD38698
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01068171
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: