Provider Demographics
NPI:1275671349
Name:ALGRAIN, HAITHAM A (MD)
Entity Type:Individual
Prefix:
First Name:HAITHAM
Middle Name:A
Last Name:ALGRAIN
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 1:2809 BOSTON ST APT 406
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4852
Mailing Address - Country:US
Mailing Address - Phone:202-302-7034
Mailing Address - Fax:
Practice Address - Street 1:2809 BOSTON ST APT 406
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4852
Practice Address - Country:US
Practice Address - Phone:202-302-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT1719207L00000X
MDD0069283207L00000X
PAMD440938207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102532059Medicaid
PA1593513OtherGATEWAY
PA416569OtherUPMC
PA2523051OtherHIGHMARK BLUE SHIELD
MD03663400Medicaid
PA30086354OtherAMERIHEALTH MERCY - YH
PA2523051OtherHIGHMARK BLUE SHIELD
PA196010EZ3Medicare PIN
PA1593513OtherGATEWAY