Basic Information
| Provider Information | |||||||||
| NPI: | 1689962839 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EL ADO MIKDACHI | ||||||||
| FirstName: | HANA | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 J CLYDE MORRIS BLVD | ||||||||
| Address2: | RIVERSIDE REGIONAL MC,DEPT. OF MEDICAL EDUCATION OB/GYN | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 N STATE OF FRANKLIN RD FL 1 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397272 | ||||||||
| FaxNumber: | 4234397235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD56382 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 0116023546 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.