Provider Demographics
NPI:1285637462
Name:ELBAHLAWAN, LAMA MA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAMA
Middle Name:MA
Last Name:ELBAHLAWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAMA
Other - Middle Name:MA
Other - Last Name:ALBAHLAWAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN378492080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64082142Medicaid
LA1470881Medicaid
AR154139001Medicaid
TN5440117Medicaid
KS200379190AMedicaid
ME422400000Medicaid
OK200077380AMedicaid
MS08958791Medicaid
AL009971325Medicaid
MO208967505Medicaid
IN200512820AMedicaid
AL009971325Medicaid