Provider Demographics
NPI:1619323367
Name:AL DALAHMAH, OSAMA AHMAD ODEH (MD)
Entity Type:Individual
Prefix:DR
First Name:OSAMA
Middle Name:AHMAD ODEH
Last Name:AL DALAHMAH
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 1:630 WEST , 168TH STREET
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY AND CELL BIOLOGY, ROOM PH15-124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:212-305-7012
Mailing Address - Fax:
Practice Address - Street 1:630 WEST , 168TH STREET
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY AND CELL BIOLOGY, ROOM PH15-124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-7012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2021-12-20
Deactivation Date:2017-01-05
Deactivation Code:
Reactivation Date:2020-04-29
Provider Licenses
StateLicense IDTaxonomies
DCMD047974207ZN0500X, 207ZP0101X
390200000X
NY305676207ZN0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program