Provider Demographics
NPI:1205826112
Name:ALAIDROOS, HANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HANIA
Middle Name:
Last Name:ALAIDROOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17610 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5734
Mailing Address - Country:US
Mailing Address - Phone:972-931-0100
Mailing Address - Fax:972-931-0400
Practice Address - Street 1:17610 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5734
Practice Address - Country:US
Practice Address - Phone:972-931-0100
Practice Address - Fax:972-931-0400
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI25094Medicare UPIN