Provider Demographics
NPI:1932192945
Name:AL-HADDADIN, DAFER W (MD)
Entity Type:Individual
Prefix:
First Name:DAFER
Middle Name:W
Last Name:AL-HADDADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAFER
Other - Middle Name:W
Other - Last Name:HADDADIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:155 BORTHWICK AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7156
Mailing Address - Country:US
Mailing Address - Phone:603-434-8733
Mailing Address - Fax:603-433-8834
Practice Address - Street 1:155 BORTHWICK AVE STE 202
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7156
Practice Address - Country:US
Practice Address - Phone:603-434-8733
Practice Address - Fax:603-433-8834
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008004909207RI0200X
TNMD38698207RI0200X
IN01068171207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00467411OtherRAILROAD MEDICARE
OK200132160AMedicaid
KS200546850AMedicaid
MO208360206Medicaid
221420OtherBLUES
IN200984520Medicaid
P00467411OtherRAILROAD MEDICARE
IN200984520Medicaid