Provider Demographics
NPI:1194088047
Name:ALWASIYAH, DALIA MOHAMMEDTAREQ (MD)
Entity type:Individual
Prefix:DR
First Name:DALIA
Middle Name:MOHAMMEDTAREQ
Last Name:ALWASIYAH
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 1:309 ECLIPSE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-6737
Mailing Address - Country:US
Mailing Address - Phone:910-660-1897
Mailing Address - Fax:
Practice Address - Street 1:309 ECLIPSE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-6737
Practice Address - Country:US
Practice Address - Phone:910-660-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210413207P00000X, 207PT0002X
NC2016-02272207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical ToxicologyGroup - Multi-Specialty