Basic Information
Provider Information | |||||||||
NPI: | 1932339868 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HANNA | ||||||||
FirstName: | WAEL | ||||||||
MiddleName: | ADEL SAMUEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 689 | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181051556 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1150 N BISHOP AVE STE 100 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752084168 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143582300 | ||||||||
FaxNumber: | 2145796983 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2009 | ||||||||
LastUpdateDate: | 09/01/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/01/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | S7227 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD446500 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RN0300X | S7227 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | MT194179 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208M00000X | MD446500 | PA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207RN0300X | 58743 | AZ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
ID | Type | State | Issuer | Description | 102747034 | 05 | PA |   | MEDICAID | S7227 | 01 | TX | TX MEDICAL LICENSE | OTHER |