Provider Demographics
NPI:1790994929
Name:AL HARIRI, ADHAM BASSAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ADHAM
Middle Name:BASSAM
Last Name:AL HARIRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ADHAM
Other - Middle Name:BASSAM
Other - Last Name:AL HARIRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3715 PRYTANIA ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3761
Mailing Address - Country:US
Mailing Address - Phone:504-895-3223
Mailing Address - Fax:504-895-3224
Practice Address - Street 1:3715 PRYTANIA ST
Practice Address - Street 2:SUITE 504
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3761
Practice Address - Country:US
Practice Address - Phone:504-895-3223
Practice Address - Fax:504-895-3224
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203136207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05771000Medicaid
LA1074527Medicaid
LA4M9197061Medicare PIN
LA1074527Medicaid