Provider Demographics
NPI:1154350965
Name:AKOURY, DALAL A (MD)
Entity type:Individual
Prefix:
First Name:DALAL
Middle Name:A
Last Name:AKOURY
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 1:4710 OLEANDER DRIVE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5898
Mailing Address - Country:US
Mailing Address - Phone:843-213-1480
Mailing Address - Fax:843-712-1973
Practice Address - Street 1:4710 OLEANDER DRIVE
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5898
Practice Address - Country:US
Practice Address - Phone:843-213-1480
Practice Address - Fax:843-712-1973
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046726207P00000X
NC9800006207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00387371OtherRAILROAD MEDICARE
VA010289661Medicaid
VA3069481Medicaid
TN3136318OtherBLUE CROSS BLUE SHEILD
VA010256135Medicaid
TN3069481Medicaid
SCAA50909326Medicare PIN
TN3069481Medicare PIN
TNP00387371OtherRAILROAD MEDICARE