Provider Demographics
NPI:1336324896
Name:ADADA, HAYTHAM FARUQ (MD)
Entity Type:Individual
Prefix:
First Name:HAYTHAM
Middle Name:FARUQ
Last Name:ADADA
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 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR STE 312D
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7664
Practice Address - Country:US
Practice Address - Phone:276-258-1100
Practice Address - Fax:276-258-1745
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009016606207R00000X
VA0101251575207R00000X, 207RC0200X, 207RP1001X
TN46374207R00000X, 207RP1001X
PAMT187604390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100185780Medicaid
TNP00885378OtherRAILROAD MEDICARE
MO1336324896Medicaid
VA1336324896Medicaid
431560263OtherTRICARE WEST
P00739159OtherRAILROAD MEDICARE
NC1336324896Medicaid
TN1521185Medicaid
11995962OtherCAQH ID
TNP00885378OtherRAILROAD MEDICARE
VAVVD174AMedicare PIN
MO1336324896Medicaid