Provider Demographics
NPI:1205062346
Name:ALBATAINEH, MOHAMMAD T III (CSA)
Entity type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:T
Last Name:ALBATAINEH
Suffix:III
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 W PIONEER DR
Mailing Address - Street 2:APT 1224
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-3891
Mailing Address - Country:US
Mailing Address - Phone:817-487-9213
Mailing Address - Fax:
Practice Address - Street 1:4519 W PIONEER DR
Practice Address - Street 2:APT 1224
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-3891
Practice Address - Country:US
Practice Address - Phone:817-487-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09-194246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant