Provider Demographics
NPI:1235106154
Name:RAHAL, NIDAL (MD)
Entity type:Individual
Prefix:
First Name:NIDAL
Middle Name:
Last Name:RAHAL
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 1:943 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-7734
Mailing Address - Country:US
Mailing Address - Phone:901-279-4360
Mailing Address - Fax:901-358-9010
Practice Address - Street 1:7820 WALKING HORSE CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2143
Practice Address - Country:US
Practice Address - Phone:901-279-4360
Practice Address - Fax:901-358-9010
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40310207RG0300X, 207RH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148597001Medicaid
ARH75018Medicare UPIN
AR57317Medicare ID - Type Unspecified
AR148597001Medicaid