Provider Demographics
NPI:1164485173
Name:ABDEL-RAHMAN, HOSSAM ABDELMONEM (MEDIAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:HOSSAM
Middle Name:ABDELMONEM
Last Name:ABDEL-RAHMAN
Suffix:
Gender:M
Credentials:MEDIAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 POINCIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554
Mailing Address - Country:US
Mailing Address - Phone:337-468-3099
Mailing Address - Fax:337-468-3083
Practice Address - Street 1:803 POINCIANA AVE
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554
Practice Address - Country:US
Practice Address - Phone:337-468-3099
Practice Address - Fax:337-468-3083
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12356R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1538485Medicaid
LA4A227C895Medicare ID - Type Unspecified
LA1538485Medicaid