1861440380 NPI number — DR. SAMIR S EL DAHR MD

Table of content: DR. SAMIR S EL DAHR MD (NPI 1861440380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861440380 NPI number — DR. SAMIR S EL DAHR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EL DAHR
Provider First Name:
SAMIR
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EL-DAHR
Provider Other First Name:
MOHAMMED SAMIR
Provider Other Middle Name:
SAYEM
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861440380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 TULANE AVE
Provider Second Line Business Mailing Address:
SL-37
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-988-5456
Provider Business Mailing Address Fax Number:
504-988-1771

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 TULANE AVE
Provider Second Line Business Practice Location Address:
HC-18, 5TH FLOOR
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70112-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-988-6253
Provider Business Practice Location Address Fax Number:
504-988-7654
Provider Enumeration Date:
05/05/2006

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: 2080P0210X , with the licence number:  MD.08505R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1901563 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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