Provider Demographics
NPI:1164618278
Name:FALLAHIAN, AMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:FALLAHIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011146402085R0202X
VA01012648852085R0202X
LA3090232085R0202X
IA452712085R0202X
MN23512085R0202X
AL374962085R0202X
KS04-376692085R0202X
OK309552085R0202X
TN574762085R0202X
MTMED-PHYS-LIC-647742085R0202X
MO20180126762085R0202X
CAA1106832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12172836OtherCAQH
AL225261Medicaid
AL225752Medicaid
AL225757Medicaid
AL240027Medicaid
AL242920Medicaid
AL243171Medicaid
AL225264Medicaid
AL225750Medicaid
AL225864Medicaid
AL225872Medicaid
AL242825Medicaid
AL890-51518OtherBCBS
AL242869Medicaid
AL225663Medicaid
AL225667Medicaid
AL242813Medicaid
AL225666Medicaid
AL225869Medicaid