Provider Demographics
NPI:1568409514
Name:HADDAD, JAMAL A (DO)
Entity Type:Individual
Prefix:
First Name:JAMAL
Middle Name:A
Last Name:HADDAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5462
Mailing Address - Fax:740-446-5082
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5462
Practice Address - Fax:740-446-5082
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7309207V00000X
WV1897207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001714114OtherMOUNTAIN STATE BCBS
OH2153593OtherMOLINA MEDICAID
OH000000181640OtherUNISON MEDICAID
160046432OtherRR MEDICARE
000000196977OtherANTHEM BCBS
WV6200106000Medicaid
KY64043706Medicaid
OH2153593Medicaid
OH310917085061OtherCARESOURCE MEDICAID
OH2153593Medicaid
WV6200106000Medicaid
KY64043706Medicaid