1336168848 NPI number — DR. EMAD ALSHAMI M.D.

Table of content: DR. EMAD ALSHAMI M.D. (NPI 1336168848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336168848 NPI number — DR. EMAD ALSHAMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALSHAMI
Provider First Name:
EMAD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336168848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1060 SUMMITT DR
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45042-3400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-423-4546
Provider Business Mailing Address Fax Number:
513-423-4548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 SUMMIT DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-423-4546
Provider Business Practice Location Address Fax Number:
513-423-4548
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35-084629 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000337326 . This is a "ANTHEM ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 4136191 . This is a "MEDICARE ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P001381B . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 201167053 . This is a "TAX ID#" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 201167053-00 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2504221 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".