Healthcare Provider Details

I. General information

NPI: 1235106154
Provider Name (Legal Business Name): NIDAL RAHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7820 WALKING HORSE CIR
GERMANTOWN TN
38138-2143
US

IV. Provider business mailing address

943 WHITNEY AVE
MEMPHIS TN
38127-7734
US

V. Phone/Fax

Practice location:
  • Phone: 901-279-4360
  • Fax: 901-358-9010
Mailing address:
  • Phone: 901-279-4360
  • Fax: 901-358-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number40310
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number40310
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40310
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: