Provider Demographics
NPI:1477586022
Name:BADAHMAN, ALHASSAN M (MD)
Entity Type:Individual
Prefix:
First Name:ALHASSAN
Middle Name:M
Last Name:BADAHMAN
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 1:3155 E SOUTHERN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5519
Mailing Address - Country:US
Mailing Address - Phone:480-325-8173
Mailing Address - Fax:480-325-8179
Practice Address - Street 1:3155 E SOUTHERN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5519
Practice Address - Country:US
Practice Address - Phone:480-325-8173
Practice Address - Fax:480-325-8179
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015928207RP1001X
AZ37982207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7153373OtherAETNA NON-HMO
ME3320405OtherAETNA HMO
ME693021OtherHRVPIL
ME04659OtherANTHEM
AZZ78334OtherGROUP PTAN
ME106988OtherMARTPOINT
ME225114008OtherUNITED HEALTHCARE
MEM1064102OtherCIGNA
AZZ148046OtherPTAN MD ANDERSON
ME693021OtherHRVPIL
AZZ78334OtherGROUP PTAN
AZZ122848Medicare PIN
ME225114008OtherUNITED HEALTHCARE