Provider Demographics
NPI:1568463834
Name:ALNAHHAS, MOHAMAD HAKAM (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMAD
Middle Name:HAKAM
Last Name:ALNAHHAS
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 1:3602 CUMBERLAND AVE STE B-102
Mailing Address - Street 2:PO BOX 2898
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2614
Mailing Address - Country:US
Mailing Address - Phone:606-248-7778
Mailing Address - Fax:606-248-7787
Practice Address - Street 1:3602 CUMBERLAND AVE STE B-102
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2614
Practice Address - Country:US
Practice Address - Phone:606-248-7778
Practice Address - Fax:606-248-7787
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64298904Medicaid