Provider Demographics
NPI:1225076862
Name:AMARE, MAMMO (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMMO
Middle Name:
Last Name:AMARE
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3555 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3461
Practice Address - Country:US
Practice Address - Phone:972-709-2580
Practice Address - Fax:972-298-6485
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4692207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132756103Medicaid
TX132756107Medicaid
TX8R1383OtherBLUE CROSS OF TEXAS
TX132756105Medicaid
TX132756105Medicaid
TX132756103Medicaid
TX132756107Medicaid
TX88278KMedicare PIN
TX830001114Medicare PIN