Provider Demographics
NPI:1760645311
Name:AL-HALASEH, WAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WAEL
Middle Name:
Last Name:AL-HALASEH
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 1:306 MEDICAL CENTER DR SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3416
Mailing Address - Country:US
Mailing Address - Phone:256-845-9255
Mailing Address - Fax:256-845-9349
Practice Address - Street 1:306 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3416
Practice Address - Country:US
Practice Address - Phone:256-845-9255
Practice Address - Fax:256-845-9349
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07880900207RC0000X
ALMD28946207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1760645311Medicaid
AL510-47874OtherAL BCBS
AL510I060062Medicare PIN
AL510-47874OtherAL BCBS