Basic Information
| Provider Information | |||||||||
| NPI: | 1336324896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADADA | ||||||||
| FirstName: | HAYTHAM | ||||||||
| MiddleName: | FARUQ | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16000 JOHNSTON MEMORIAL DR | ||||||||
| Address2: | SUITE 212B | ||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242117659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762581740 | ||||||||
| FaxNumber: | 2762581745 | ||||||||
| Practice Location | |||||||||
| Address1: | 16000 JOHNSTON MEMORIAL DR | ||||||||
| Address2: | SUITE 212B | ||||||||
| City: | ABINGDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242117659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762581740 | ||||||||
| FaxNumber: | 2762581745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2008 | ||||||||
| LastUpdateDate: | 01/26/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2009016606 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | MT187604 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RP1001X | 46374 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207R00000X | 0101251575 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 46374 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 0101251575 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RC0200X | 0101251575 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1521185 | 05 | TN | MEDICAID | 1336324896 | 05 | MO | MEDICAID | 7100185780 | 05 | KY | MEDICAID | 431560263 | 01 | TRICARE WEST | OTHER | 11995962 | 01 | CAQH ID | OTHER | P00885378 | 01 | TN | RAILROAD MEDICARE | OTHER | 1336324896 | 05 | VA | MEDICAID | 1336324896 | 05 | NC | MEDICAID | P00739159 | 01 | RAILROAD MEDICARE | OTHER |