Provider Demographics
NPI:1790753945
Name:SHANABLEH, AHMAD M A (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:M A
Last Name:SHANABLEH
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 1:824 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-1940
Mailing Address - Country:US
Mailing Address - Phone:504-341-1603
Mailing Address - Fax:
Practice Address - Street 1:824 AVENUE F
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-1940
Practice Address - Country:US
Practice Address - Phone:504-341-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11385R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1662453Medicaid
LA1662453Medicaid
F73958Medicare UPIN