Provider Demographics
NPI:1730133604
Name:LAHOUD, CHAWKI A (MD)
Entity type:Individual
Prefix:
First Name:CHAWKI
Middle Name:A
Last Name:LAHOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 FAIR MEADOWS LN STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6449
Mailing Address - Country:US
Mailing Address - Phone:919-787-4000
Mailing Address - Fax:919-787-4009
Practice Address - Street 1:4505 FAIR MEADOWS LN STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-787-4000
Practice Address - Fax:919-787-4009
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501307207P00000X, 207R00000X
LA11695R207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903724Medicaid
LA1682462Medicaid
LA4E218CQ59Medicare ID - Type Unspecified
NC2229360AMedicare PIN
LAG27031Medicare UPIN
LA4E218CQ18Medicare ID - Type Unspecified