Provider Demographics
NPI:1467624619
Name:ALHADDAD, MOHSIN T (MD)
Entity Type:Individual
Prefix:
First Name:MOHSIN
Middle Name:T
Last Name:ALHADDAD
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 1:327 SUMMAR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3930
Mailing Address - Country:US
Mailing Address - Phone:731-423-8200
Mailing Address - Fax:731-423-6200
Practice Address - Street 1:327 SUMMAR DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3930
Practice Address - Country:US
Practice Address - Phone:731-423-8200
Practice Address - Fax:731-423-6200
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48826207RC0000X
KY41832207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease