1578845954 NPI number — DR. ABDEL RAHMAN ABDULLAH ALI AL MANASRA M.D.

Table of content: DR. ABDEL RAHMAN ABDULLAH ALI AL MANASRA M.D. (NPI 1578845954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578845954 NPI number — DR. ABDEL RAHMAN ABDULLAH ALI AL MANASRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AL MANASRA
Provider First Name:
ABDEL RAHMAN
Provider Middle Name:
ABDULLAH ALI
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:
1578845954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 JONATHAN LUCAS ST
Provider Second Line Business Mailing Address:
CSB 409
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29425-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-3368
Provider Business Mailing Address Fax Number:
843-792-8596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
96 JONATHAN LUCAS ST
Provider Second Line Business Practice Location Address:
CSB 409
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-3368
Provider Business Practice Location Address Fax Number:
843-792-8596
Provider Enumeration Date:
09/13/2011

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: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com