Provider Demographics
NPI:1639173487
Name:DAHER, AMIRAH HASAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIRAH
Middle Name:HASAN
Last Name:DAHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMIRAH
Other - Middle Name:HASAN
Other - Last Name:DAHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2093
Mailing Address - Fax:423-857-2012
Practice Address - Street 1:2033 MEADOWVIEW LN
Practice Address - Street 2:3RD FLOOR
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7569
Practice Address - Country:US
Practice Address - Phone:423-857-2793
Practice Address - Fax:423-578-2793
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010756112080N0001X
TNNA2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3001284Medicaid
VA1639173487Medicaid
MI451015610Medicaid
MI451015610Medicaid
TN3001284Medicare UPIN
VA1639173487Medicaid
MIH32144Medicare UPIN
TN3001284Medicaid