Provider Demographics
NPI:1457594897
Name:AL SHATHIR, MUDHER NAJAH (MD)
Entity type:Individual
Prefix:DR
First Name:MUDHER
Middle Name:NAJAH
Last Name:AL SHATHIR
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 1:4760 E GALBRAITH RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-6704
Mailing Address - Country:US
Mailing Address - Phone:513-791-4490
Mailing Address - Fax:513-791-7287
Practice Address - Street 1:4760 E GALBRAITH RD STE 206
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6704
Practice Address - Country:US
Practice Address - Phone:513-791-4490
Practice Address - Fax:513-791-7287
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52830207R00000X
VA0101251931207R00000X
OH35099669207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457594897Medicaid
VA1457594897Medicaid
TNQ016896Medicaid
TNQ016896Medicaid