Provider Demographics
NPI:1477086908
Name:MOSALLAM, AHMED HAMED (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:AHMED
Middle Name:HAMED
Last Name:MOSALLAM
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 N NORTHGATE WAY
Mailing Address - Street 2:APT 303D
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-2819
Mailing Address - Country:US
Mailing Address - Phone:425-443-7669
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-2814
Practice Address - Country:US
Practice Address - Phone:425-443-7669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60730025207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology