Provider Demographics
NPI:1861550790
Name:AL-SHAHROURI, HANIA ZIAD (MD)
Entity type:Individual
Prefix:
First Name:HANIA
Middle Name:ZIAD
Last Name:AL-SHAHROURI
Suffix:
Gender:F
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:PO BOX 11449
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:479-709-1924
Mailing Address - Fax:479-709-7499
Practice Address - Street 1:1500 DODSON AVE
Practice Address - Street 2:STE 280
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5182
Practice Address - Country:US
Practice Address - Phone:479-709-7480
Practice Address - Fax:479-709-7479
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5612207RN0300X
ARE7274207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185615503OtherCSHCN
TX8AC881OtherBCBS
TX185615502Medicaid
TX185615502Medicaid