Provider Demographics
NPI:1518936475
Name:PEDIATRIC HEMATOLOGY ONCOLOGY OF NORTH TEXAS
Entity Type:Organization
Organization Name:PEDIATRIC HEMATOLOGY ONCOLOGY OF NORTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:MORAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-566-8870
Mailing Address - Street 1:7777 FOREST LANE
Mailing Address - Street 2:SUITE B-311
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230
Mailing Address - Country:US
Mailing Address - Phone:972-566-8870
Mailing Address - Fax:972-566-8817
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:SUITE B-311
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-8870
Practice Address - Fax:972-566-8817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ37202080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000F66A8Medicaid
F63631Medicare UPIN
TXP000F66A8Medicaid