1265612618 NPI number — HAIZIA LAMIA AMSLER M.D.

Table of content: HAIZIA LAMIA AMSLER M.D. (NPI 1265612618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265612618 NPI number — HAIZIA LAMIA AMSLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMSLER
Provider First Name:
HAIZIA
Provider Middle Name:
LAMIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MECHENTEL
Provider Other First Name:
HAIZIA
Provider Other Middle Name:
LAMIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265612618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18117 IVY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832-2009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9115 LEESGATE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-429-8011
Provider Business Practice Location Address Fax Number:
502-429-6389
Provider Enumeration Date:
11/13/2007

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: 208M00000X , with the licence number:  41830 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000602803 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100078820 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000057415G . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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