Provider Demographics
NPI:1659181824
Name:ALDAHER, MOHAMAD HAYEL
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:HAYEL
Last Name:ALDAHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N ORCHARD ST STE 7
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2255
Mailing Address - Country:US
Mailing Address - Phone:208-570-4023
Mailing Address - Fax:
Practice Address - Street 1:1010 N ORCHARD ST STE 7
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2255
Practice Address - Country:US
Practice Address - Phone:208-570-4023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-10
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1659181824Medicaid