Provider Demographics
NPI:1407837503
Name:HAIDAR, AHMAD A (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:A
Last Name:HAIDAR
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 1:200 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426
Mailing Address - Country:US
Mailing Address - Phone:601-799-4777
Mailing Address - Fax:601-799-0052
Practice Address - Street 1:200 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-9037
Practice Address - Country:US
Practice Address - Phone:601-799-4777
Practice Address - Fax:601-799-0052
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS110240293OtherRAILROAD MEDICARE
LA1658723Medicaid
MS09520729OtherMEDICAID GROUP
MS302G709744OtherMEDICARE GROUP
MS00112453Medicaid
MS110240293OtherRAILROAD MEDICARE
LA1658723Medicaid