Provider Demographics
NPI:1508867516
Name:ALKOUTAMI, GHASSAN SOULTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:SOULTAN
Last Name:ALKOUTAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2660 TATE BLVD SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1465
Mailing Address - Country:US
Mailing Address - Phone:828-216-0009
Mailing Address - Fax:828-261-0109
Practice Address - Street 1:2660 TATE BLVD SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1465
Practice Address - Country:US
Practice Address - Phone:828-216-0009
Practice Address - Fax:828-261-0109
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300007207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060053896OtherRAILROAD MEDICARE
NC7910725Medicaid
NCF63455Medicare UPIN
060053896OtherRAILROAD MEDICARE