Provider Demographics
NPI:1285829440
Name:AL-LAHAM, AMMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:AL-LAHAM
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 1:3801 WILLIAM D TATE AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-8755
Mailing Address - Country:US
Mailing Address - Phone:817-488-6812
Mailing Address - Fax:817-251-1303
Practice Address - Street 1:4907 S COLLINS ST STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1157
Practice Address - Country:US
Practice Address - Phone:817-375-0610
Practice Address - Fax:817-375-0640
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0827207RN0300X
PAMD432292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX374082101Medicaid
110533OtherGEISINGER
PAP01040667OtherRAILROAD MEDICARE-WMG
PA30105534OtherAMERIHEALTH MERCY-WMG
50072046OtherBLUE CROSS/KEYSTONE
PAMD432292OtherPA MEDICAL LICENSE
P00422297OtherRAILROAD MEDICARE
9135078OtherAETNA (TRADITIONAL)
1738182OtherAETNA HMO
PA1020070770001Medicaid
PA1564188OtherGATEWAY
50072046OtherBLUE CROSS/KEYSTONE
PA1020070770001Medicaid