Provider Demographics
NPI:1487933446
Name:ALTARAWNEH, AHMAD HASHEM
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:HASHEM
Last Name:ALTARAWNEH
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 1:100 FRANKLIN ST APT 207D
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5440
Mailing Address - Country:US
Mailing Address - Phone:612-607-3289
Mailing Address - Fax:
Practice Address - Street 1:4458 MEDICAL DR STE 505
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3748
Practice Address - Country:US
Practice Address - Phone:210-690-7400
Practice Address - Fax:210-690-7405
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19287207R00000X
TXT3238207RC0200X, 207RN0300X
NJ00000000000000000000390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program