Basic Information
| Provider Information | |||||||||
| NPI: | 1396715355 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMMAR | ||||||||
| FirstName: | MOHAMMAD SAMER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153427339 | ||||||||
| FaxNumber: | 6153427340 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 23RD AVE N | ||||||||
| Address2: | SUITE 450 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153427339 | ||||||||
| FaxNumber: | 6153427340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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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 | 2080P0206X | 036-115594 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 2080P0206X | 48766 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3274132 | 05 | TN | MEDICAID | 4329055 | 01 | BCBS | OTHER | 036115594 | 05 | IL | MEDICAID |