Provider Demographics
NPI:1679094189
Name:HANAYNEH, WISSAM BASSEL JAMIL (MD)
Entity type:Individual
Prefix:
First Name:WISSAM
Middle Name:BASSEL JAMIL
Last Name:HANAYNEH
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 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-2739
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 230
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-470-2739
Practice Address - Fax:337-470-2739
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA336875207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program